Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 4013 | OK |
NPI | 1053486175 |
---|---|
Provider Name | Joy M. Beckerley |
First Address | Oklahoma City, OK 73117-1214 |
Second Address | Oklahoma City, OK 73117-1214 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2006 |
Last Update Date | 08/07/2007 |