Provider Demographics
NPI:1588032379
Name:FORD, JANE BECKWITH (DDS)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:BECKWITH
Last Name:FORD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:JANE
Other - Middle Name:MARIE
Other - Last Name:BECKWITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:531 E 9TH STREET
Mailing Address - Street 2:BUILDING 357
Mailing Address - City:FT STEWART
Mailing Address - State:GA
Mailing Address - Zip Code:31314
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:531 E 9TH STREET
Practice Address - Street 2:BUILDING 357
Practice Address - City:FT STEWART
Practice Address - State:GA
Practice Address - Zip Code:31314
Practice Address - Country:US
Practice Address - Phone:912-435-7009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-10
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12012341A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist