Healthcare Provider Details

I. General information

NPI: 1740270065
Provider Name (Legal Business Name): MARK E BEEHNER M.D., D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 05/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9741 N 90TH PL
SCOTTSDALE AZ
85258
US

IV. Provider business mailing address

27913 N WALNUT CREEK RD
RIO VERDE AZ
85263-5243
US

V. Phone/Fax

Practice location:
  • Phone: 480-657-7065
  • Fax: 480-657-7066
Mailing address:
  • Phone: 480-259-5730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number015171
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberD008817
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number37000
License Number StateMO
# 4
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number49215
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: