Provider Demographics
NPI:1629224241
Name:BEVERLY HEALTH DEPARTMENT DENTAL CLINIC
Entity Type:Organization
Organization Name:BEVERLY HEALTH DEPARTMENT DENTAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PUBLIC HEALTH
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:T
Authorized Official - Last Name:BURKE
Authorized Official - Suffix:III
Authorized Official - Credentials:RS CHO
Authorized Official - Phone:978-921-8591
Mailing Address - Street 1:90 COLON ST
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-3604
Mailing Address - Country:US
Mailing Address - Phone:978-921-8591
Mailing Address - Fax:978-922-5695
Practice Address - Street 1:90 COLON ST
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-3604
Practice Address - Country:US
Practice Address - Phone:978-921-8591
Practice Address - Fax:978-922-5695
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CITY OF BEVERLY HEALTH DEPARTIMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-08-14
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA44FV251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare