Provider Demographics
NPI:1942268420
Name:BEERNINK, GREGORY D (DDS)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:D
Last Name:BEERNINK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 LINCOLN CIR SE
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51041-1861
Mailing Address - Country:US
Mailing Address - Phone:712-737-4177
Mailing Address - Fax:712-737-8718
Practice Address - Street 1:909 LINCOLN CIR SE
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:IA
Practice Address - Zip Code:51041-1861
Practice Address - Country:US
Practice Address - Phone:712-737-4177
Practice Address - Fax:712-737-8718
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA69601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1216309Medicaid