Provider Demographics
NPI:1134742430
Name:BEINLICH, MADELINE (DDS)
Entity type:Individual
Prefix:DR
First Name:MADELINE
Middle Name:
Last Name:BEINLICH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MADELINE
Other - Middle Name:
Other - Last Name:CARNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:511RIVERST.
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55401
Mailing Address - Country:US
Mailing Address - Phone:630-379-8419
Mailing Address - Fax:
Practice Address - Street 1:11949 CENTRAL AVE NE
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55434
Practice Address - Country:US
Practice Address - Phone:763-757-8253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-20
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNTBD122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist