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NPI Code Detail

MEDICARE: DR. MACKENSIE JANE TAPPE MCBEAIN DDS

MEDICARE: DR. MACKENSIE JANE TAPPE MCBEAIN DDS
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
1390200000XStudent in an Organized Health Care Education/Training Program
2122300000XDentistD13436MN

General Provider Information

NPI Number : 1598177271
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MACKENSIE JANE TAPPE MCBEAIN DDS
Provider Business Mailing Address
First Line : 3359 W BROADWAY AVE
Second Line :
City : ROBBINSDALE
State : MN
Zip : 55422-2928
Country : US
Telephone Number : 312-996-1052
Fax Number : 312-996-5987
Provider Business Practice Location Address
First Line : 3359 W BROADWAY AVE
Second Line :
City : ROBBINSDALE
State : MN
Zip : 55422-2928
Country : US
Telephone Number : 763-270-5776
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/28/2014
Last Update Date : 10/30/2018

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