Individual
MR. KEN A. BECKERMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
109 W BROADWAY ST, PRINCETON, IN 47670-1501
(812) 385-2750
(812) 385-2878
Mailing address
109 W BROADWAY ST, PO BOX 462, PRINCETON, IN 47670-1501
(812) 385-2750
(812) 385-2878
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
12007838
IN
1223G0001X
General Practice Dentistry
12007838
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1437299989
INDIVIDUAL NPI
IN
Enumeration date
02/07/2007
Last updated
01/24/2017
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