Provider Demographics
NPI:1598177271
Name:MCBEAIN, MACKENSIE JANE TAPPE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MACKENSIE
Middle Name:JANE TAPPE
Last Name:MCBEAIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MACKENSIE
Other - Middle Name:JANE
Other - Last Name:TAPPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3359 W BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:ROBBINSDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55422-2928
Mailing Address - Country:US
Mailing Address - Phone:312-996-1052
Mailing Address - Fax:312-996-5987
Practice Address - Street 1:3359 W BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:ROBBINSDALE
Practice Address - State:MN
Practice Address - Zip Code:55422-2928
Practice Address - Country:US
Practice Address - Phone:763-270-5776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-28
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MND13436122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program