MEDICARE: BECKLEY GENERAL DENTISTRY, PROFESSIONAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1619819828
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BECKLEY GENERAL DENTISTRY, PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	30627 MISSION ST
Second Line	:
City	:	HIGHLAND
State	:	CA
Zip	:	92346-6343
Country	:	US
Telephone Number	:	909-262-8416
Fax Number	:	909-262-8416

Provider Business Practice Location Address
First Line	:	6850 BROCKTON AVE STE 110
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92506-3814
Country	:	US
Telephone Number	:	951-683-6221
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MELISA RAQUEL BECKLEY
Credential	:	BECKLEY
Telephone Number	:	909-262-8416

Provider Enumeration Date	:	04/07/2026
Last Update Date	:	04/07/2026

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