Healthcare Provider Details

I. General information

NPI: 1730203159
Provider Name (Legal Business Name): PHILLIP JULIAN BECKWITH D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

829 EASTWIND DR
WESTERVILLE OH
43081-3303
US

IV. Provider business mailing address

829 EASTWIND DR
WESTERVILLE OH
43081-3303
US

V. Phone/Fax

Practice location:
  • Phone: 614-882-5391
  • Fax: 614-882-2063
Mailing address:
  • Phone: 614-882-5391
  • Fax: 614-882-2063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number15039
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: