Provider Demographics
NPI:1215197462
Name:BEUCKENS, MEGAN LEIGH (DDS)
Entity Type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:LEIGH
Last Name:BEUCKENS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1660 HIGHWAY 100 S
Mailing Address - Street 2:SUITE 122
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55416-1529
Mailing Address - Country:US
Mailing Address - Phone:952-544-4129
Mailing Address - Fax:952-544-7489
Practice Address - Street 1:1660 HIGHWAY 100 S
Practice Address - Street 2:SUITE 122
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55416-1529
Practice Address - Country:US
Practice Address - Phone:952-544-4129
Practice Address - Fax:952-544-7489
Is Sole Proprietor?:No
Enumeration Date:2008-06-11
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND12555122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist