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General NPI Number Information
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NPI Number | 1932418480
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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 | 10/01/2010
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Last Update Date | 12/22/2010
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Provider Practice Location Address
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Address Line | 102 8TH AVE S
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City | FAULKTON
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State | SD
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Zip | 57438-2115
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Country | US
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Telephone | 605-598-4452
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Fax | 605-598-4280
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Provider Business Mailing Address
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Address Line | PO BOX 534
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City | FAULKTON
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State | SD
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Zip | 57438-0534
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Country | US
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Telephone | 605-598-4452
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Fax | 605-598-4280
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Authorized Official
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Title or Position | OWNER
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Name | GREGG 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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | M664
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License Number State | SD
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