Provider Demographics
NPI:1669161451
Name:BECKWITH, JORDAN (RDH)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:BECKWITH
Suffix:
Gender:M
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 S SHERMAN ST APT 100
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-1639
Mailing Address - Country:US
Mailing Address - Phone:208-850-4978
Mailing Address - Fax:
Practice Address - Street 1:4301 E AMHERST AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-6790
Practice Address - Country:US
Practice Address - Phone:720-410-9841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-05
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO002025965124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist