Provider Demographics
NPI:1558321828
Name:BECKMAN, THOMAS WALTER (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:WALTER
Last Name:BECKMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 S. MEDICAL PARK DR.
Mailing Address - Street 2:
Mailing Address - City:FISHERVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22939
Mailing Address - Country:US
Mailing Address - Phone:540-886-2956
Mailing Address - Fax:540-886-2284
Practice Address - Street 1:54 S. MEDICAL PARK DR.
Practice Address - Street 2:
Practice Address - City:FISHERVILLE
Practice Address - State:VA
Practice Address - Zip Code:22939
Practice Address - Country:US
Practice Address - Phone:540-886-2956
Practice Address - Fax:540-886-2284
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040680-11223S0112X
OH30-0222931223S0112X
VA04380002531223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
178969OtherDORAL
178969OtherDORAL