Provider Demographics
NPI:1255412961
Name:BEINLICH, GREG STEVEN (DDS,MS)
Entity type:Individual
Prefix:
First Name:GREG
Middle Name:STEVEN
Last Name:BEINLICH
Suffix:
Gender:M
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:9950 VALLEY CREEK RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-4883
Mailing Address - Country:US
Mailing Address - Phone:651-702-1462
Mailing Address - Fax:651-702-3828
Practice Address - Street 1:9950 VALLEY CREEK RD
Practice Address - Street 2:SUITE 150
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-4883
Practice Address - Country:US
Practice Address - Phone:651-702-1462
Practice Address - Fax:651-702-3828
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN105451223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry