Provider Demographics
NPI:1447590542
Name:BECKMAN, DEBORAH ANN (RDH)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ANN
Last Name:BECKMAN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2264
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-0634
Mailing Address - Country:US
Mailing Address - Phone:503-334-5100
Mailing Address - Fax:
Practice Address - Street 1:3604 SE POWELL VALLEY RD
Practice Address - Street 2:136
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97080-1606
Practice Address - Country:US
Practice Address - Phone:503-334-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-26
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH2857124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist