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NPI Code Detail

MEDICARE: RENEE CASSIDY INGRAM BECHLY D.M.D.

MEDICARE: RENEE CASSIDY INGRAM BECHLY D.M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223P0221XPediatric DentistryRENEEING123MN

General Provider Information

NPI Number : 1154178887
Entity Type Code : Individual
Provider Name (Legal Business Name) : RENEE CASSIDY INGRAM BECHLY D.M.D.
Provider Business Mailing Address
First Line : 3950 VETERANS DR
Second Line :
City : SAINT CLOUD
State : MN
Zip : 56303-3410
Country : US
Telephone Number : 320-253-8380
Fax Number :
Provider Business Practice Location Address
First Line : 3950 VETERANS DR
Second Line :
City : SAINT CLOUD
State : MN
Zip : 56303-3410
Country : US
Telephone Number : 320-253-8380
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/01/2024
Last Update Date : 06/29/2026

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