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General NPI Number Information
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NPI Number | 1588055925
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Entity Type | Organization
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Legal Business Name | BEACON FAMILY DENTAL
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Dates
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Enumeration Date | 02/06/2015
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Last Update Date | 02/06/2015
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Provider Practice Location Address
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Address Line | 1691 BEACON ST SUITE 104
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City | BROOKLINE
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State | MA
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Zip | 02445-4400
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Country | US
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Telephone | 617-738-6188
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Fax | 857-284-8828
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Provider Business Mailing Address
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Address Line | 1691 BEACON ST SUITE 104
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City | BROOKLINE
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State | MA
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Zip | 02445-4400
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Country | US
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Telephone | 617-738-6188
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Fax | 857-284-8828
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | DR. XINYAN LUCY LIU
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Credential | DMD
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Telephone | 617-738-6188
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN1855149
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License Number State | MA
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