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General NPI Number Information
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NPI Number | 1477638294
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Entity Type | Organization
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Legal Business Name | DRS MIELKE BAYLON & BEINLICH
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Dates
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Enumeration Date | 10/27/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1809 NORTHWESTERN AVE #100
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City | STILLWATER
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State | MN
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Zip | 55082-7521
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Country | US
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Telephone | 651-439-5640
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Fax | 651-439-9739
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Provider Business Mailing Address
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Address Line | 1809 NORTHWESTERN AVE #100
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City | STILLWATER
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State | MN
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Zip | 55082-7521
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Country | US
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Telephone | 651-439-5640
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Fax | 651-439-9739
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Authorized Official
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Title or Position | PARTNER
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Name | DR. GREG STEVEN BEINLICH
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Credential | DDS MS
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Telephone | 651-439-5640
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 8325
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 10545
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 7329
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License Number State | MN
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