Provider Demographics
NPI:1619231602
Name:BEAUDOIN, PAUL E (DMD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:E
Last Name:BEAUDOIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:PAUL
Other - Middle Name:E
Other - Last Name:BEAUDOIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:2 STILSON STREET
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04073
Mailing Address - Country:US
Mailing Address - Phone:207-324-8699
Mailing Address - Fax:207-490-5501
Practice Address - Street 1:2 STILSON STREET
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:ME
Practice Address - Zip Code:04073
Practice Address - Country:US
Practice Address - Phone:207-324-8699
Practice Address - Fax:207-490-5501
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-25
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDEN4253122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist