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General NPI Number Information
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NPI Number | 1356452916
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Entity Type | Organization
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Legal Business Name | GREGG VAN BEEK DDS PC
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3015 6TH AVE SE SUITE 12
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City | ABERDEEN
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State | SD
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Zip | 57401-5460
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Country | US
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Telephone | 605-226-3939
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Fax | 605-226-3428
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Provider Business Mailing Address
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Address Line | 3015 6TH AVE SE NORTHEASTERN DENTAL CENTER SUITE 12
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City | ABERDEEN
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State | SD
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Zip | 57401-5460
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Country | US
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Telephone | 605-226-3939
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Fax | 605-226-3428
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Authorized Official
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Title or Position | DENTIST OWNER
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Name | MR. GREGG EDWARD VAN BEEK
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Credential | DDS
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Telephone | 605-226-3939
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | M664
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License Number State | SD
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