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General NPI Number Information
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NPI Number | 1235342452
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Entity Type | Organization
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Legal Business Name | JAY A. BEAUCHEMIN, DDS, PA
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Dates
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Enumeration Date | 05/07/2007
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Last Update Date | 05/11/2009
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Provider Practice Location Address
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Address Line | 110 MAIN ST SUITE 1218
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City | SACO
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State | ME
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Zip | 04072-3509
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Country | US
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Telephone | 207-284-4007
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Fax |
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Provider Business Mailing Address
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Address Line | 110 MAIN ST SUITE 1218
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City | SACO
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State | ME
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Zip | 04072-3509
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Country | US
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Telephone | 207-284-4007
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JAY A. BEAUCHEMIN
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Credential | D.D.S.
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Telephone | 207-284-4007
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 3159
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License Number State | ME
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