Provider Demographics
NPI:1710999206
Name:BEAUDRY, ROBERT J (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:J
Last Name:BEAUDRY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 SHORE RD
Mailing Address - Street 2:
Mailing Address - City:MERRIMAC
Mailing Address - State:MA
Mailing Address - Zip Code:01860-1223
Mailing Address - Country:US
Mailing Address - Phone:978-346-8546
Mailing Address - Fax:
Practice Address - Street 1:13 SHORE RD
Practice Address - Street 2:
Practice Address - City:MERRIMAC
Practice Address - State:MA
Practice Address - Zip Code:01860-1223
Practice Address - Country:US
Practice Address - Phone:978-345-8546
Practice Address - Fax:978-346-4301
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA185331223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics