Provider Demographics
NPI:1376918300
Name:BEACHWOOD DENTAL ARTS, LLC
Entity Type:Organization
Organization Name:BEACHWOOD DENTAL ARTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:CHECKETT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:732-349-0555
Mailing Address - Street 1:659 ATLANTIC CITY BLVD
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08722-4007
Mailing Address - Country:US
Mailing Address - Phone:732-349-0555
Mailing Address - Fax:
Practice Address - Street 1:659 ATLANTIC CITY BLVD
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08722-4007
Practice Address - Country:US
Practice Address - Phone:732-349-0555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-02
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI20081122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty