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General NPI Number Information
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NPI Number | 1619191178
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Entity Type | Organization
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Legal Business Name | RICHARD L. BECKERMEYER, D. D. S., P.C.
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Dates
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Enumeration Date | 04/13/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 123 MARMONT ST
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City | NILES
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State | MI
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Zip | 49120-1657
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Country | US
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Telephone | 269-683-6461
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Fax | 269-683-7618
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Provider Business Mailing Address
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Address Line | 123 MARMONT ST
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City | NILES
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State | MI
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Zip | 49120-1657
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Country | US
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Telephone | 269-683-6461
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Fax | 269-683-7618
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MRS. CYNTHIA BECKERMEYER
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Credential |
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Telephone | 269-683-6461
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 16779
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License Number State | MI
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