Provider Demographics
NPI:1477965051
Name:BECKMANN, KAYANNA SUZANNE (DMD)
Entity Type:Individual
Prefix:DR
First Name:KAYANNA
Middle Name:SUZANNE
Last Name:BECKMANN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4240 W KENNEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-2231
Mailing Address - Country:US
Mailing Address - Phone:813-636-7400
Mailing Address - Fax:
Practice Address - Street 1:4240 W KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-2231
Practice Address - Country:US
Practice Address - Phone:813-636-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-29
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN20604122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist