Organization
BEVERLY DENTISTRY AND BRACES PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JOANNE TAVANO (CFO)
(978) 580-1524
Entity
Organization
Contact information
Practice address
55 DODGE ST STE A-190, BEVERLY, MA 01915-1705
(508) 872-3072
(508) 872-0781
Mailing address
5 MOUNT ROYAL AVE STE 300, MARLBOROUGH, MA 01752-1900
(508) 872-3072
(508) 872-0781
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110078301A
—
MA
Enumeration date
01/19/2021
Last updated
01/19/2021
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