Provider Demographics
NPI:1700937620
Name:BEATTIE VONMUENSTER, MARIANNA REBECCA (DDS)
Entity type:Individual
Prefix:DR
First Name:MARIANNA
Middle Name:REBECCA
Last Name:BEATTIE VONMUENSTER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:MARIANNA
Other - Middle Name:REBECCA
Other - Last Name:BEATTIE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:2344 HIGHWAY 130
Mailing Address - Street 2:
Mailing Address - City:NEW LIBERTY
Mailing Address - State:IA
Mailing Address - Zip Code:52765
Mailing Address - Country:US
Mailing Address - Phone:563-893-2260
Mailing Address - Fax:
Practice Address - Street 1:516 W 35TH ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52806-5821
Practice Address - Country:US
Practice Address - Phone:563-386-6910
Practice Address - Fax:563-386-6967
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA08167122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist