Provider Demographics
NPI:1952962458
Name:MICHAEL BECKERMAN DMD & ASSOCIATES, LLC
Entity Type:Organization
Organization Name:MICHAEL BECKERMAN DMD & ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:BECKERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:678-523-9007
Mailing Address - Street 1:512 W BANKHEAD HWY
Mailing Address - Street 2:
Mailing Address - City:VILLA RICA
Mailing Address - State:GA
Mailing Address - Zip Code:30180-1703
Mailing Address - Country:US
Mailing Address - Phone:770-459-5197
Mailing Address - Fax:770-459-5146
Practice Address - Street 1:512 W BANKHEAD HWY
Practice Address - Street 2:
Practice Address - City:VILLA RICA
Practice Address - State:GA
Practice Address - Zip Code:30180-1703
Practice Address - Country:US
Practice Address - Phone:770-459-5197
Practice Address - Fax:770-459-5146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-25
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty