Provider Demographics
NPI:1588604938
Name:BECKERMAN, SCOTT M (DMD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:M
Last Name:BECKERMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 CRESCENT SHORE RD
Mailing Address - Street 2:
Mailing Address - City:RAYMOND
Mailing Address - State:ME
Mailing Address - Zip Code:04071-6122
Mailing Address - Country:US
Mailing Address - Phone:207-627-4447
Mailing Address - Fax:
Practice Address - Street 1:1 WILLOW RUN
Practice Address - Street 2:UNIT 1-B
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-8501
Practice Address - Country:US
Practice Address - Phone:207-783-0261
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME34791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice