Provider Demographics
NPI:1770755654
Name:BEYOND YOUR SMILE, PC
Entity type:Organization
Organization Name:BEYOND YOUR SMILE, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-875-1060
Mailing Address - Street 1:254 COCHITUATE RD
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01701-4627
Mailing Address - Country:US
Mailing Address - Phone:508-875-1060
Mailing Address - Fax:508-875-0620
Practice Address - Street 1:254 COCHITUATE RD
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01701-4627
Practice Address - Country:US
Practice Address - Phone:508-875-1060
Practice Address - Fax:508-875-0620
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BEYOND YOUR SMILE, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-31
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18131261QD0000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
X07438OtherBLUE CROSS BLUE SHIELD