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NPI Code Detail

MEDICARE: BEACON DENTAL CENTER

MEDICARE: BEACON DENTAL CENTER
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
11223G0001XGeneral Practice Dentistry13522MI
21223G0001XGeneral Practice Dentistry19909MI

General Provider Information

NPI Number : 1205205267
Entity Type Code : Organization
Provider Name (Legal Business Name) : BEACON DENTAL CENTER
Provider Business Mailing Address
First Line : 6483 M 66 N
Second Line :
City : CHARLEVOIX
State : MI
Zip : 49720-9272
Country : US
Telephone Number : 231-547-9141
Fax Number :
Provider Business Practice Location Address
First Line : 6483 M 66 N
Second Line :
City : CHARLEVOIX
State : MI
Zip : 49720-9272
Country : US
Telephone Number : 231-547-9141
Fax Number : 231-547-5077
Authorized Official
Title or Position : OWNER / DOCTOR
Name : DR. MICHAEL A SULLIVAN
Credential : DDS
Telephone Number : 231-547-9141
Provider Enumeration Date : 09/21/2015
Last Update Date : 09/21/2015

Similar Medicare Providers

1073048542 — EMILY K STEVENS LMSW
Practice Location Address:
6250 M 66 N
CHARLEVOIX, MI
49720-9272
Practice Phone: 231-547-5885
Practice Fax:
1700150638 — MS. NINA KAY MARTENSON TLLP
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1225469067 — STEPHANIE L VANNIMAN LMSW
Practice Location Address:
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1235560814 — MICHALENE M WRIGHT RN
Practice Location Address:
6250 M 66 N
CHARLEVOIX, MI
49720-9272
Practice Phone: 231-547-5885
Practice Fax: 231-547-0136
1104331834 — AMANDA HERSCHER
Practice Location Address:
6250 M 66 N
CHARLEVOIX, MI
49720-9272
Practice Phone: 231-547-5885
Practice Fax:
1427550417 — ERIKA R COLLINS AT, PTA
Practice Location Address:
6510 M 66 N
CHARLEVOIX, MI
49720-9272
Practice Phone: 231-547-0380
Practice Fax: 231-547-0395

Directions to “BEACON DENTAL CENTER ” Practice Location

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