Provider Demographics
NPI:1578778874
Name:ROBERT J. BEAUDRY JR., D.M.D., INC.
Entity Type:Organization
Organization Name:ROBERT J. BEAUDRY JR., D.M.D., INC.
Other - Org Name:BEAUDRY ORAL SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:BEAUDRY
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:717-763-7630
Mailing Address - Street 1:3600 OLD GETTYSBURG ROAD
Mailing Address - Street 2:
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011
Mailing Address - Country:US
Mailing Address - Phone:717-763-7630
Mailing Address - Fax:717-730-7396
Practice Address - Street 1:3600 OLD GETTYSBURG RD
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011
Practice Address - Country:US
Practice Address - Phone:717-763-7630
Practice Address - Fax:717-730-7396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty