Kelly Patrick Beckham Jr., DDS

Primary specialty

DentistTaxonomy code 122300000X

License

28999 Issued in TX

Practice address

4702 Kingfisher Dr
Houston, TX 77035-4920

Phone

(832) 244-2770

NPI assigned

May 28, 2013

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jun 6, 2016 through Jun 6, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Westside Dental PLLC

  • Dentist
  • Pearland, TX
  • NPI 1801382486
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1369699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1369699200000",
    "number": "1891132114",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4702 KINGFISHER DR",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770354920"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4702 KINGFISHER DR",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770354920",
            "telephone_number": "832-244-2770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BECKHAM",
        "first_name": "KELLY",
        "middle_name": "PATRICK",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-05-28",
        "last_updated": "2013-05-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TX",
            "license": "28999",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hazel Audreline Beckford-Flemming, RN, FNP, MSN
• Tamara S Beckford, MD
• Jacquelinne Beckham
• James Beckham
• Jamie Lee Beckham, OT
• Thomas Hendrix Beckham, MD, PHD
• Ariel Beckley
• Bradley Irwin Beckman, MD
• Jenifer Beckman, LPC
• Randall L Beckman, DPM

• Dentist in Houston, TX
• Providers in Houston, TX by specialty
• Dentist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.