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General NPI Number Information
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NPI Number | 1104994110
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Entity Type | Organization
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Legal Business Name | RIVERSIDE DENTAL-ROBERT C. BEATTIE, DDS & ASSOCIATES PC
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Dates
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Enumeration Date | 11/30/2006
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Last Update Date | 07/15/2008
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Provider Practice Location Address
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Address Line | 404 1ST ST. N.
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City | PRINCETON
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State | MN
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Zip | 55371
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Country | US
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Telephone | 763-389-3320
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Fax | 763-631-0662
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Provider Business Mailing Address
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Address Line | 404 1ST ST. N.
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City | PRINCETON
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State | MN
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Zip | 55371
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Country | US
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Telephone | 763-389-3320
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Fax | 763-631-0662
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Authorized Official
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Title or Position | CEO
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Name | DR. ROBERT C. BEATTIE
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Credential | DDS
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Telephone | 763-389-3320
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 7787
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License Number State | MN
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