Provider Demographics
NPI:1689396988
Name:BEACH PERIO, IMPLANTS & MEDSPA
Entity Type:Organization
Organization Name:BEACH PERIO, IMPLANTS & MEDSPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:CIANCIOLA-BEACH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:585-314-8160
Mailing Address - Street 1:509 WHITE RABBIT TRL
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14612-2894
Mailing Address - Country:US
Mailing Address - Phone:585-314-8160
Mailing Address - Fax:
Practice Address - Street 1:2109 S CLINTON AVE # 146
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-2615
Practice Address - Country:US
Practice Address - Phone:585-314-8160
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-13
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental