Healthcare Provider Details

I. General information

NPI: 1154178887
Provider Name (Legal Business Name): RENEE CASSIDY INGRAM BECHLY D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2024
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3950 VETERANS DR
SAINT CLOUD MN
56303-3410
US

IV. Provider business mailing address

3950 VETERANS DR
SAINT CLOUD MN
56303-3410
US

V. Phone/Fax

Practice location:
  • Phone: 320-253-8380
  • Fax:
Mailing address:
  • Phone: 320-253-8380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberD15310
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: