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General NPI Number Information
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NPI Number | 1992073456
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Entity Type | Individual
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Provider Name | MARIANNE BEAULIEU DESOUZA R.D.H.
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Gender | Female
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Dates
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Enumeration Date | 12/12/2011
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Last Update Date | 12/12/2011
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Provider Practice Location Address
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Address Line | 1213 PURCHASE ST 1ST FLOOR
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City | NEW BEDFORD
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State | MA
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Zip | 02740-6694
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Country | US
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Telephone | 508-991-6288
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Fax | 508-991-6291
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Provider Business Mailing Address
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Address Line | 1027 IVERS ST
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City | NEW BEDFORD
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State | MA
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Zip | 02745-4402
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Country | US
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Telephone | 774-628-9878
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Fax | 774-628-9878
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 4990
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License Number State | MA
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