Healthcare Provider Details

I. General information

NPI: 1265730063
Provider Name (Legal Business Name): MICHELLE BECKERLY DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2011
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 E 22ND ST STE A
LOMBARD IL
60148-6102
US

IV. Provider business mailing address

649 THOMAS DR
BENSENVILLE IL
60106-1622
US

V. Phone/Fax

Practice location:
  • Phone: 630-216-4544
  • Fax:
Mailing address:
  • Phone: 630-216-4544
  • Fax: 630-233-4002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019028755
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: