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General NPI Number Information
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NPI Number | 1558874172
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Entity Type | Organization
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Legal Business Name | BEACON ORTHODONTIC ASSOCIATES, P.C.
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Dates
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Enumeration Date | 11/06/2017
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Last Update Date | 11/06/2017
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Provider Practice Location Address
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Address Line | 651 WASHINGTON ST STE 100
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City | BROOKLINE
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State | MA
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Zip | 02446-4518
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Country | US
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Telephone | 617-738-4746
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Fax | 617-738-3334
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Provider Business Mailing Address
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Address Line | 651 WASHINGTON STREET SUITE 100
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City | BROOKLINE
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State | MA
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Zip | 02446
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Country | US
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Telephone | 617-738-4746
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Fax | 617-738-3334
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. SHARI N. LISANN
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Credential | D.M.D.
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Telephone | 617-738-4746
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 16176
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License Number State | MA
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