=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245478023
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DENTAL-BEAN INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/02/2009
-----------------------------------------------------
Last Update Date | 02/02/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 174 LITTLETON RD DENTAL-BEAN
-----------------------------------------------------
City | WESTFORD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01886
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-988-1298
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 174 LITTLETON RD DENTAL-BEAN
-----------------------------------------------------
City | WESTFORD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01886
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-988-1298
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. JOHN L GUERIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 978-988-1298
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------