Organization
GREGG VAN BEEK DDS PC
Active
Other names
Northeastern Dental Center
Organization subpart
No
Provider details
NPI number
Authorized official
GREGG VAN BEEK DDS (OWNER)
(605) 226-3939
Entity
Organization
Contact information
Practice address
102 8TH AVE S, FAULKTON, SD 57438-2115
(605) 598-4452
(605) 598-4280
Mailing address
PO BOX 534, FAULKTON, SD 57438-0534
(605) 598-4452
(605) 598-4280
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
M664
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7805395
—
SD
Enumeration date
10/01/2010
Last updated
12/22/2010
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