Healthcare Provider Details

I. General information

NPI: 1407556707
Provider Name (Legal Business Name): GERARD JEAN-LUC BEAUCHAMP DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2023
Last Update Date: 09/29/2026
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9593 NW 41ST ST
DORAL FL
33178-2914
US

IV. Provider business mailing address

9408 NW 54TH DORAL CIRCLE LN
DORAL FL
33178-2048
US

V. Phone/Fax

Practice location:
  • Phone: 305-594-2022
  • Fax:
Mailing address:
  • Phone: 305-562-0374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN29137
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: