Healthcare Provider Details

I. General information

NPI: 1447590542
Provider Name (Legal Business Name): DEBORAH ANN BECKMAN RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2013
Last Update Date: 02/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3604 SE POWELL VALLEY RD 136
GRESHAM OR
97080-1606
US

IV. Provider business mailing address

PO BOX 2264
GRESHAM OR
97030-0634
US

V. Phone/Fax

Practice location:
  • Phone: 503-334-5100
  • Fax:
Mailing address:
  • Phone: 503-334-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberH2857
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: