Provider Demographics
NPI:1447699335
Name:GROENKE, BETH RENEE (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:BETH
Middle Name:RENEE
Last Name:GROENKE
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:RENEE
Other - Last Name:MORREY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:406 WACOUTA ST UNIT 713
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55101-2054
Mailing Address - Country:US
Mailing Address - Phone:816-813-7212
Mailing Address - Fax:
Practice Address - Street 1:7600 FRANCE AVE S STE 100
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-5924
Practice Address - Country:US
Practice Address - Phone:888-964-6681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-24
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013016374122300000X, 1223X2210X
CO204120122300000X, 1223X2210X
MND146651223X2210X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223X2210XDental ProvidersDentistOrofacial Pain