=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740286095
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LEONARD DOUGLAS BECKHAM DMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/22/2005
-----------------------------------------------------
Last Update Date | 01/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | UNIVERSITY OF ALABAMA SCHOOL OF DENTISTRY 1919 7TH AVENUE, SOUTH
-----------------------------------------------------
City | BIRMINGHAM
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35233-5079
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-934-3000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3144 IRIS DR
-----------------------------------------------------
City | HOOVER
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35244-5079
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-447-1949
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 3228
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------