Healthcare Provider Details

I. General information

NPI: 1942951306
Provider Name (Legal Business Name): BEACON DENTAL HEALTH MA II PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2022
Last Update Date: 01/17/2022
Certification Date: 01/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1645 FALMOUTH RD
CENTERVILLE MA
02632-2932
US

IV. Provider business mailing address

135 PINELAWN RD STE 150S
MELVILLE NY
11747-3187
US

V. Phone/Fax

Practice location:
  • Phone: 617-297-9773
  • Fax: 631-392-0452
Mailing address:
  • Phone: 631-414-7927
  • Fax: 631-396-0452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: HIRO SORIANO
Title or Position: CIO
Credential:
Phone: 516-344-5746