Healthcare Provider Details

I. General information

NPI: 1043316557
Provider Name (Legal Business Name): ANDREA R BECKFORD DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 09/24/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9045 US HIGHWAY 31
BERRIEN SPRINGS MI
49103-1804
US

IV. Provider business mailing address

9045 US HIGHWAY 31 STE 1
BERRIEN SPRINGS MI
49103-1804
US

V. Phone/Fax

Practice location:
  • Phone: 989-533-1888
  • Fax: 269-471-9232
Mailing address:
  • Phone: 269-471-5244
  • Fax: 269-471-9232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number1023
License Number StateGU
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number2901022137
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number12013410A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: