Provider Demographics
NPI:1477638294
Name:DRS MIELKE BAYLON & BEINLICH
Entity Type:Organization
Organization Name:DRS MIELKE BAYLON & BEINLICH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:BEINLICH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:651-439-5640
Mailing Address - Street 1:1809 NORTHWESTERN AVE
Mailing Address - Street 2:#100
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-7521
Mailing Address - Country:US
Mailing Address - Phone:651-439-5640
Mailing Address - Fax:651-439-9739
Practice Address - Street 1:1809 NORTHWESTERN AVE
Practice Address - Street 2:#100
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-7521
Practice Address - Country:US
Practice Address - Phone:651-439-5640
Practice Address - Fax:651-439-9739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN73291223P0221X
MN83251223P0221X
MN105451223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HP53816OtherHEALTHPARTNERS GRP
33554300OtherDR PETER H MIELKE INDIVID
33678600OtherDR RICHARD J BAYLON INDIV
33732300OtherDR GREG S BEINLICH INDIVI