Provider Demographics
NPI:1538176078
Name:BECKNER, CHRISTOPHER WILSON (DDS)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:WILSON
Last Name:BECKNER
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 1:422 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45013-4717
Mailing Address - Country:US
Mailing Address - Phone:513-856-8253
Mailing Address - Fax:513-856-8253
Practice Address - Street 1:422 MAIN ST
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45013-4717
Practice Address - Country:US
Practice Address - Phone:513-856-8253
Practice Address - Fax:513-856-8253
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH184801223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHBE0707611Medicare ID - Type Unspecified