MEDICARE: DR. RICHARD GINO BEAUCHEMIN D.D.S., F.A.G.D.

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	1223G0001X	General Practice Dentistry	014050	MI

General Provider Information

NPI Number	:	1922114727
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD GINO BEAUCHEMIN D.D.S., F.A.G.D.

Provider Business Mailing Address
First Line	:	48788 POINT LAKEVIEW ST
Second Line	:
City	:	CHESTERFIELD
State	:	MI
Zip	:	48047-3418
Country	:	US
Telephone Number	:	586-566-2014
Fax Number	:

Provider Business Practice Location Address
First Line	:	4333 METROPOLITAN PKWY
Second Line	:	SUITE A
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-4524
Country	:	US
Telephone Number	:	586-264-0650
Fax Number	:

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

Provider Enumeration Date	:	08/22/2006
Last Update Date	:	07/08/2007

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