Healthcare Provider Details

I. General information

NPI: 1699269084
Provider Name (Legal Business Name): ERIC BEAUDET DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2018
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1117 MEDICAL CENTER DR
WILMINGTON NC
28401-7304
US

IV. Provider business mailing address

2206 E MARSHALL ST
RICHMOND VA
23223-7059
US

V. Phone/Fax

Practice location:
  • Phone: 910-350-3508
  • Fax:
Mailing address:
  • Phone: 248-860-6108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number0401418844
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number12146
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: