Provider Demographics
NPI:1831299890
Name:BEENE, JOHN MARTIN II (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MARTIN
Last Name:BEENE
Suffix:II
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:JOHN
Other - Middle Name:MARTIN
Other - Last Name:BEENE
Other - Suffix:II
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:7560 RANGEWOOD DR
Mailing Address - Street 2:#300
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-4199
Mailing Address - Country:US
Mailing Address - Phone:719-272-9009
Mailing Address - Fax:719-272-9889
Practice Address - Street 1:7560 RANGEWOOD DR
Practice Address - Street 2:#300
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-4199
Practice Address - Country:US
Practice Address - Phone:719-272-9009
Practice Address - Fax:719-272-9889
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO70181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO870648OtherUNITED CONCORDIA