Provider Demographics
NPI:1255901401
Name:BECKSTEAD, DAVIS E (DDS)
Entity type:Individual
Prefix:
First Name:DAVIS
Middle Name:E
Last Name:BECKSTEAD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:824 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94301-2134
Mailing Address - Country:US
Mailing Address - Phone:650-810-5765
Mailing Address - Fax:
Practice Address - Street 1:105 SOUTH DR STE 200
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-4317
Practice Address - Country:US
Practice Address - Phone:650-747-8268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-29
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1063341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty