Provider Demographics
NPI:1366518391
Name:BECKWITH FAMILY DENTAL CARE PLC
Entity type:Organization
Organization Name:BECKWITH FAMILY DENTAL CARE PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:HASSE
Authorized Official - Last Name:KIRKWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:616-459-0478
Mailing Address - Street 1:1726 LEONARD ST NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49505-5636
Mailing Address - Country:US
Mailing Address - Phone:616-459-0478
Mailing Address - Fax:616-742-6021
Practice Address - Street 1:1726 LEONARD ST NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49505-5636
Practice Address - Country:US
Practice Address - Phone:616-459-0478
Practice Address - Fax:616-742-6021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901013583122300000X
MI2901018904122300000X
MI2901016145122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty