Provider Demographics
NPI:1811066590
Name:ORANGE CITY DENTISTRY, INC
Entity type:Organization
Organization Name:ORANGE CITY DENTISTRY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:D
Authorized Official - Last Name:BEERNINK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:712-737-4177
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA69601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1216309Medicaid
IA27707OtherBLUE CROSS BLUE SHEILD