Provider Demographics
NPI:1730563990
Name:BECKLEY, STEFANIE M (DMD)
Entity type:Individual
Prefix:DR
First Name:STEFANIE
Middle Name:M
Last Name:BECKLEY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 SE BASELINE ST
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123
Mailing Address - Country:US
Mailing Address - Phone:503-648-3912
Mailing Address - Fax:541-504-3907
Practice Address - Street 1:550 SE BASELINE ST
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4114
Practice Address - Country:US
Practice Address - Phone:503-648-3912
Practice Address - Fax:541-504-3907
Is Sole Proprietor?:No
Enumeration Date:2015-07-16
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD10282122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist