Provider Demographics
NPI:1437228673
Name:BEAUMONT, ROBERT HOWARD (DMD MSD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:HOWARD
Last Name:BEAUMONT
Suffix:
Gender:M
Credentials:DMD MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1657 LAKELAND CIRCLE
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55038
Mailing Address - Country:US
Mailing Address - Phone:651-762-0136
Mailing Address - Fax:
Practice Address - Street 1:1657 LAKELAND CIRCLE
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:MN
Practice Address - Zip Code:55038
Practice Address - Country:US
Practice Address - Phone:651-762-0136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND105781223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics