MEDICARE: BEVERLY FARMS DENTAL PLLC

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1881180156
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEVERLY FARMS DENTAL PLLC

Provider Business Mailing Address
First Line	:	772 E 4TH ST UNIT 4
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02127-3241
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	50 WEST ST
Second Line	:
City	:	BEVERLY
State	:	MA
Zip	:	01915-2228
Country	:	US
Telephone Number	:	617-291-6007
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	DR. ANDREW LUCCIO
Credential	:
Telephone Number	:	617-291-6007

Provider Enumeration Date	:	07/10/2018
Last Update Date	:	07/10/2018

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