MEDICARE: MICHELLE BECKERLY DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	019028755	IL

General Provider Information

NPI Number	:	1265730063
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE BECKERLY DMD

Provider Business Mailing Address
First Line	:	649 THOMAS DR
Second Line	:
City	:	BENSENVILLE
State	:	IL
Zip	:	60106-1622
Country	:	US
Telephone Number	:	630-216-4544
Fax Number	:	630-233-4002

Provider Business Practice Location Address
First Line	:	4845 N MILWAUKEE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60630-2145
Country	:	US
Telephone Number	:	630-216-4544
Fax Number	:	630-233-4002

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/03/2011
Last Update Date	:	11/28/2025

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