Brandon S Beaudoin, D.M.D.

Primary specialty

DentistTaxonomy code 122300000X

License

DL11582 Issued in MA

Practice address

119 Windsor St
Cambridge, MA 02139-3647

Phone

(617) 665-3990

NPI assigned

Jun 26, 2012

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Nov 16, 2016 through Nov 16, 2026

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Brandon Beaudoin DMD PLLC

  • Dental Clinic/Center
  • Bedford, NH
  • NPI 1336890995
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1340668800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1340668800000",
    "number": "1093079816",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "170 BROOKLINE AVE",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022153937",
            "telephone_number": "978-270-1848"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "119 WINDSOR ST",
            "city": "CAMBRIDGE",
            "state": "MA",
            "postal_code": "021393647",
            "telephone_number": "617-665-3990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BEAUDOIN",
        "first_name": "BRANDON",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-06-26",
        "last_updated": "2012-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MA",
            "license": "DL11582",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Huseyin Bayazit, MD
• Baycove Human Services
• Asli Baykal, PHD
• Adam Bazari
• Silvana Bazua Valenti, PHD
• Amy N Bebergal, LICSW
• James Ciora Beck, MD PHD
• Stuart Beck
• Brian William Becker, PH.D.
• David I Becker, MD

• Dentist in Cambridge, MA
• Providers in Cambridge, MA by specialty
• Dentist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.