Provider Demographics
NPI:1245254432
Name:BEAUCHAMP, BARRY ROBERT (DDS)
Entity type:Individual
Prefix:
First Name:BARRY
Middle Name:ROBERT
Last Name:BEAUCHAMP
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 1:2162 HUNTERS PARK E
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR
Mailing Address - State:MI
Mailing Address - Zip Code:48079-4013
Mailing Address - Country:US
Mailing Address - Phone:810-329-5211
Mailing Address - Fax:810-765-6460
Practice Address - Street 1:342 W SAINT CLAIR ST
Practice Address - Street 2:
Practice Address - City:MARINE CITY
Practice Address - State:MI
Practice Address - Zip Code:48039-3544
Practice Address - Country:US
Practice Address - Phone:810-765-9200
Practice Address - Fax:810-765-6460
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010151171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice