Provider Demographics
NPI:1467715250
Name:Y. E BECKFORD DDS PC
Entity Type:Organization
Organization Name:Y. E BECKFORD DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:BECKFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-939-9293
Mailing Address - Street 1:3983 LAVISTA RD
Mailing Address - Street 2:#181
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-5153
Mailing Address - Country:US
Mailing Address - Phone:770-939-9293
Mailing Address - Fax:
Practice Address - Street 1:3983 LAVISTA RD
Practice Address - Street 2:#181
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-5153
Practice Address - Country:US
Practice Address - Phone:770-939-9293
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-18
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA10300122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty