Provider Demographics
NPI:1740270065
Name:BEEHNER, MARK E (MD, DDS)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:E
Last Name:BEEHNER
Suffix:
Gender:M
Credentials:MD, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27913 N WALNUT CREEK RD
Mailing Address - Street 2:
Mailing Address - City:RIO VERDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85263-5243
Mailing Address - Country:US
Mailing Address - Phone:480-259-5730
Mailing Address - Fax:
Practice Address - Street 1:9741 N 90TH PL
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258
Practice Address - Country:US
Practice Address - Phone:480-657-7065
Practice Address - Fax:480-657-7066
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-27
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0151711223S0112X
AZD0088171223S0112X
MO37000208600000X
AZ49215208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery