MEDICARE: RICHARD G. BEAUCHEMIN D.D.S., P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1124492939
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICHARD G. BEAUCHEMIN D.D.S., P.C.

Provider Business Mailing Address
First Line	:	4333 METROPOLITAN PKWY
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-4521
Country	:	US
Telephone Number	:	586-264-0650
Fax Number	:

Provider Business Practice Location Address
First Line	:	4333 METROPOLITAN PKWY
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-4521
Country	:	US
Telephone Number	:	586-264-0650
Fax Number	:

Authorized Official
Title or Position	:	PARTNER, MANAGER
Name	:	DR. RICHARD GINO BEAUCHEMIN
Credential	:	DDS
Telephone Number	:	586-264-0650

Provider Enumeration Date	:	11/17/2015
Last Update Date	:	11/17/2015

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