Provider Demographics
NPI:1811739386
Name:BECKERDITE, ABIGAIL (DMD)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:
Last Name:BECKERDITE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 HAWK RUN DR
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-3780
Mailing Address - Country:US
Mailing Address - Phone:636-614-8299
Mailing Address - Fax:
Practice Address - Street 1:1809 HOMER M ADAMS PKWY STE A
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-5606
Practice Address - Country:US
Practice Address - Phone:618-433-3410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-06
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.035172122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist