Provider Demographics
NPI:1730203159
Name:BECKWITH, PHILLIP JULIAN (DDS)
Entity type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:JULIAN
Last Name:BECKWITH
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 1:829 EASTWIND DR
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-3303
Mailing Address - Country:US
Mailing Address - Phone:614-882-5391
Mailing Address - Fax:614-882-2063
Practice Address - Street 1:829 EASTWIND DR
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-3303
Practice Address - Country:US
Practice Address - Phone:614-882-5391
Practice Address - Fax:614-882-2063
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH150391223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics