1831299890 NPI number — DR. JOHN MARTIN BEENE II D.D.S.

Table of content: SARAH THOMAS HUTCHINSON PA-C (NPI 1770866139)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831299890 NPI number — DR. JOHN MARTIN BEENE II D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BEENE
Provider First Name:
JOHN
Provider Middle Name:
MARTIN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
II
Provider Credential Text:
D.D.S.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BEENE
Provider Other First Name:
JOHN
Provider Other Middle Name:
MARTIN
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
II
Provider Other Credential Text:
D.D.S.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1831299890
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:
7560 RANGEWOOD DR
Provider Second Line Business Mailing Address:
#300
Provider Business Mailing Address City Name:
COLORADO SPRINGS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80920-4199
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-272-9009
Provider Business Mailing Address Fax Number:
719-272-9889

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7560 RANGEWOOD DR
Provider Second Line Business Practice Location Address:
#300
Provider Business Practice Location Address City Name:
COLORADO SPRINGS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80920-4199
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-272-9009
Provider Business Practice Location Address Fax Number:
719-272-9889
Provider Enumeration Date:
09/22/2006

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: 1223G0001X , with the licence number:  7018 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 870648 . This is a "UNITED CONCORDIA" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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