Provider Demographics
NPI:1003111618
Name:BE-CO-ME LLC
Entity Type:Organization
Organization Name:BE-CO-ME LLC
Other - Org Name:AULT FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:ECKHARDT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:970-834-2058
Mailing Address - Street 1:PO BOX 1038
Mailing Address - Street 2:
Mailing Address - City:AULT
Mailing Address - State:CO
Mailing Address - Zip Code:80610-1038
Mailing Address - Country:US
Mailing Address - Phone:970-834-2058
Mailing Address - Fax:
Practice Address - Street 1:120 NORTH 2ND AVENUE
Practice Address - Street 2:
Practice Address - City:AULT
Practice Address - State:CO
Practice Address - Zip Code:80610
Practice Address - Country:US
Practice Address - Phone:970-834-2058
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-13
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN91571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty