1700937620 NPI number — DR. MARIANNA REBECCA BEATTIE VONMUENSTER DDS

Table of content: DR. MARIANNA REBECCA BEATTIE VONMUENSTER DDS (NPI 1700937620)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700937620 NPI number — DR. MARIANNA REBECCA BEATTIE VONMUENSTER DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BEATTIE VONMUENSTER
Provider First Name:
MARIANNA
Provider Middle Name:
REBECCA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BEATTIE
Provider Other First Name:
MARIANNA
Provider Other Middle Name:
REBECCA
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DDS
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1700937620
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2344 HIGHWAY 130
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW LIBERTY
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52765
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
563-893-2260
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
516 W 35TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DAVENPORT
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52806-5821
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
563-386-6910
Provider Business Practice Location Address Fax Number:
563-386-6967
Provider Enumeration Date:
01/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  08167 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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