Provider Demographics
NPI:1487961611
Name:CHARLES P BECKWELL, DDS,PLC
Entity type:Organization
Organization Name:CHARLES P BECKWELL, DDS,PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:BECKWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-777-6440
Mailing Address - Street 1:22301 GREATER MACK AVE
Mailing Address - Street 2:STE # 1
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-2376
Mailing Address - Country:US
Mailing Address - Phone:586-777-6440
Mailing Address - Fax:586-777-3195
Practice Address - Street 1:22301 GREATER MACK AVE
Practice Address - Street 2:STE # 1
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-2376
Practice Address - Country:US
Practice Address - Phone:586-777-6440
Practice Address - Fax:586-777-3195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-09
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010148571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty