Healthcare Provider Details

I. General information

NPI: 1366750119
Provider Name (Legal Business Name): GARY JON BEIER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2010
Last Update Date: 08/24/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 DARLING LN
LAC DU FLAMBEAU WI
54538-9727
US

IV. Provider business mailing address

3600 DARLING LN
LAC DU FLAMBEAU WI
54538-9727
US

V. Phone/Fax

Practice location:
  • Phone: 715-588-7579
  • Fax:
Mailing address:
  • Phone: 715-588-7579
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number5000129-15
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: