Provider Demographics
NPI:1669055315
Name:BEACON DENTAL HEALTH RI, PC
Entity type:Organization
Organization Name:BEACON DENTAL HEALTH RI, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RISHI
Authorized Official - Middle Name:
Authorized Official - Last Name:SHUKLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-418-6940
Mailing Address - Street 1:198 TREMONT ST STE 436
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-4705
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1051 TEN ROD RD UNIT 5
Practice Address - Street 2:
Practice Address - City:NORTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02852-4163
Practice Address - Country:US
Practice Address - Phone:617-418-6940
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BEACON DENTAL HEALTH RI, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-04-30
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty