Provider Demographics
NPI:1174700603
Name:BEAUDOIN, DENIS EDWARD (DDS)
Entity type:Individual
Prefix:DR
First Name:DENIS
Middle Name:EDWARD
Last Name:BEAUDOIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:878 MAIN STREET
Mailing Address - Street 2:PO BOX 355
Mailing Address - City:WALDOBORO
Mailing Address - State:ME
Mailing Address - Zip Code:04572
Mailing Address - Country:US
Mailing Address - Phone:207-832-5181
Mailing Address - Fax:207-832-5181
Practice Address - Street 1:878 MAIN ST
Practice Address - Street 2:
Practice Address - City:WALDOBORO
Practice Address - State:ME
Practice Address - Zip Code:04572
Practice Address - Country:US
Practice Address - Phone:207-832-5181
Practice Address - Fax:207-832-5181
Is Sole Proprietor?:No
Enumeration Date:2008-01-28
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME2477122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist