Provider Demographics
NPI:1871988113
Name:TELFORD, BECKI J (DDS)
Entity type:Individual
Prefix:DR
First Name:BECKI
Middle Name:J
Last Name:TELFORD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2003 BURTON ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-4600
Mailing Address - Country:US
Mailing Address - Phone:616-245-9830
Mailing Address - Fax:616-245-5026
Practice Address - Street 1:2003 BURTON ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49506-4600
Practice Address - Country:US
Practice Address - Phone:616-245-9830
Practice Address - Fax:616-245-5026
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-03
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901015225122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist