Provider Demographics
NPI:1437446994
Name:BEAUDOIN, BRAD A (DMD)
Entity Type:Individual
Prefix:
First Name:BRAD
Middle Name:A
Last Name:BEAUDOIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:194 MAIN ST STE 1R
Mailing Address - Street 2:
Mailing Address - City:AMESBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01913-3609
Mailing Address - Country:US
Mailing Address - Phone:978-834-6695
Mailing Address - Fax:978-834-6945
Practice Address - Street 1:194 MAIN ST STE 1R
Practice Address - Street 2:
Practice Address - City:AMESBURY
Practice Address - State:MA
Practice Address - Zip Code:01913-3609
Practice Address - Country:US
Practice Address - Phone:978-834-6695
Practice Address - Fax:978-834-6945
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-06
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18564151223X0400X, 122300000X
MEDEN4193122300000X
NH04023122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist