=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740270065
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARK E BEEHNER M.D., D.D.S.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/27/2005
-----------------------------------------------------
Last Update Date | 05/15/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9741 N 90TH PL
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85258
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-657-7065
-----------------------------------------------------
Fax | 480-657-7066
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 27913 N WALNUT CREEK RD
-----------------------------------------------------
City | RIO VERDE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85263-5243
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-259-5730
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223S0112X
-----------------------------------------------------
Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
-----------------------------------------------------
License Number | 015171
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223S0112X
-----------------------------------------------------
Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
-----------------------------------------------------
License Number | D008817
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | 37000
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | 49215
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------