Robert Howard Beaumont, DMD MSD
Individual provider Active NPI Periodontics · Centerville, MN
NPI 1437228673 · NPPES record last updated Jun 23, 2015
Key facts
- NPI
- 1437228673
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Periodontics 1223P0300X
- License
- D10578 (MN)
- Practice address
- 1657 Lakeland Circle
Centerville, MN 55038 - Phone
- (651) 762-0136
- NPI assigned
- Nov 6, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D10578 | MN | MD | Periodontist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | D10578 | MN | Yes |
Addresses
Primary practice location
1657 Lakeland Circle
Centerville, MN 55038
Mailing address
1657 Lakeland Circle
Centerville, MN 55038
Phone (651) 762-0136
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All providers in Centerville, MN · Periodontics in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 23, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.