Provider Demographics
NPI:1740350214
Name:BECKWITH, CARMEN (DDS)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:
Last Name:BECKWITH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 10TH ST
Mailing Address - Street 2:
Mailing Address - City:BERTHOUD
Mailing Address - State:CO
Mailing Address - Zip Code:80513-1380
Mailing Address - Country:US
Mailing Address - Phone:970-532-4477
Mailing Address - Fax:970-532-3377
Practice Address - Street 1:408 10TH ST
Practice Address - Street 2:
Practice Address - City:BERTHOUD
Practice Address - State:CO
Practice Address - Zip Code:80513-1380
Practice Address - Country:US
Practice Address - Phone:970-532-4477
Practice Address - Fax:970-532-3377
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7575122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist