Provider Demographics
NPI:1659793552
Name:BECKNER, ROBERT ARNOLD II (LD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:ARNOLD
Last Name:BECKNER
Suffix:II
Gender:M
Credentials:LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 SE MARLIN AVE
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:OR
Mailing Address - Zip Code:97146-9624
Mailing Address - Country:US
Mailing Address - Phone:503-836-7711
Mailing Address - Fax:
Practice Address - Street 1:327 SE MARLIN AVE
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:OR
Practice Address - Zip Code:97146-9624
Practice Address - Country:US
Practice Address - Phone:503-836-7711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-10
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDT-DO 10157767122400000X
WADN 60404066122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist