Provider Demographics
NPI:1619191178
Name:RICHARD L. BECKERMEYER, D. D. S., P.C.
Entity Type:Organization
Organization Name:RICHARD L. BECKERMEYER, D. D. S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BECKERMEYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-683-6461
Mailing Address - Street 1:123 MARMONT ST
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:MI
Mailing Address - Zip Code:49120-1657
Mailing Address - Country:US
Mailing Address - Phone:269-683-6461
Mailing Address - Fax:269-683-7618
Practice Address - Street 1:123 MARMONT ST
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:MI
Practice Address - Zip Code:49120-1657
Practice Address - Country:US
Practice Address - Phone:269-683-6461
Practice Address - Fax:269-683-7618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI16779261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental