Basic Information
| Provider Information | |||||||||
| NPI: | 1003014184 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BEERS | ||||||||
| FirstName: | ADAM | ||||||||
| MiddleName: | RUSSELL | ||||||||
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| Credential: | D.D.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 9 | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MN | ||||||||
| PostalCode: | 560870009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5077234375 | ||||||||
| FaxNumber: | 5077234378 | ||||||||
| Practice Location | |||||||||
| Address1: | 602 N JACKSON AVE | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MN | ||||||||
| PostalCode: | 560874502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5077234375 | ||||||||
| FaxNumber: | 5077234378 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2007 | ||||||||
| LastUpdateDate: | 12/05/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | D12269 | MN | Y | Dental Providers | Dentist | General Practice |
No ID Information.