Provider Demographics
NPI:1659734028
Name:DR MICHAEL BECKHAM DDS PC
Entity Type:Organization
Organization Name:DR MICHAEL BECKHAM DDS PC
Other - Org Name:BECKHAM DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:BECKHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-214-9060
Mailing Address - Street 1:4815 E CAREFREE HWY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CAVE CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85331-4718
Mailing Address - Country:US
Mailing Address - Phone:480-214-9060
Mailing Address - Fax:480-214-9063
Practice Address - Street 1:4815 E CAREFREE HWY
Practice Address - Street 2:SUITE 102
Practice Address - City:CAVE CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85331-4718
Practice Address - Country:US
Practice Address - Phone:480-214-9060
Practice Address - Fax:480-214-9063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-01
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD027631223G0001X
AZ7554460001332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty