Provider Demographics
NPI:1578554119
Name:BEUTTENMULLER, ERHARD ALFRED (DDS)
Entity Type:Individual
Prefix:DR
First Name:ERHARD
Middle Name:ALFRED
Last Name:BEUTTENMULLER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:10205 NORTH RIVA RIDGE LOOP
Mailing Address - Street 2:US ARMY DENTAL ACTIVITY ATT CREDENTIALS
Mailing Address - City:FORT DRUM
Mailing Address - State:NY
Mailing Address - Zip Code:13602-5005
Mailing Address - Country:US
Mailing Address - Phone:315-772-4342
Mailing Address - Fax:315-772-9692
Practice Address - Street 1:10205 NORTH RIVA RIDGE LOOP
Practice Address - Street 2:US ARMY DENTAL ACTIVITY ATTN CREDENTIALS
Practice Address - City:FORT DRUM
Practice Address - State:NY
Practice Address - Zip Code:13602-5005
Practice Address - Country:US
Practice Address - Phone:315-772-4342
Practice Address - Fax:315-772-9692
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY0345831223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYVAD000Medicare UPIN