Provider Demographics
NPI:1356452916
Name:GREGG VAN BEEK DDS PC
Entity Type:Organization
Organization Name:GREGG VAN BEEK DDS PC
Other - Org Name:NORTHEASTERN DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGG
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:VAN BEEK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:605-226-3939
Mailing Address - Street 1:3015 6TH AVE SE
Mailing Address - Street 2:NORTHEASTERN DENTAL CENTER SUITE 12
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57401-5460
Mailing Address - Country:US
Mailing Address - Phone:605-226-3939
Mailing Address - Fax:605-226-3428
Practice Address - Street 1:3015 6TH AVE SE
Practice Address - Street 2:SUITE 12
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-5460
Practice Address - Country:US
Practice Address - Phone:605-226-3939
Practice Address - Fax:605-226-3428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDM664122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty