Provider Demographics
NPI:1730880675
Name:BECKLEY FAMILY DENTAL GROUP, PC
Entity type:Organization
Organization Name:BECKLEY FAMILY DENTAL GROUP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDTN/SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:STEFANIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:BECKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:541-784-8305
Mailing Address - Street 1:23 FALSTAFF ST
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-1901
Mailing Address - Country:US
Mailing Address - Phone:541-784-8305
Mailing Address - Fax:
Practice Address - Street 1:146 SW 2ND AVE
Practice Address - Street 2:
Practice Address - City:CANBY
Practice Address - State:OR
Practice Address - Zip Code:97013-4152
Practice Address - Country:US
Practice Address - Phone:503-266-5596
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-16
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental