MEDICARE: DR. ROBERT J BEAUDRY DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223E0200X	Endodontics	18533	MA

General Provider Information

NPI Number	:	1710999206
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT J BEAUDRY DDS

Provider Business Mailing Address
First Line	:	13 SHORE RD
Second Line	:
City	:	MERRIMAC
State	:	MA
Zip	:	01860-1223
Country	:	US
Telephone Number	:	978-346-8546
Fax Number	:

Provider Business Practice Location Address
First Line	:	13 SHORE RD
Second Line	:
City	:	MERRIMAC
State	:	MA
Zip	:	01860-1223
Country	:	US
Telephone Number	:	978-345-8546
Fax Number	:	978-346-4301

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2006
Last Update Date	:	08/03/2011

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