MEDICARE: BECK DENTAL SURGERY PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QS0112X	Oral and Maxillofacial Surgery Clinic/Center

General Provider Information

NPI Number	:	1184401622
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BECK DENTAL SURGERY PLLC

Provider Business Mailing Address
First Line	:	8406 HALL RD STE 100
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77075-4911
Country	:	US
Telephone Number	:	832-791-3039
Fax Number	:	832-930-7716

Provider Business Practice Location Address
First Line	:	8406 HALL RD STE 100
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77075-4911
Country	:	US
Telephone Number	:	832-791-3039
Fax Number	:	832-930-7716

Authorized Official
Title or Position	:	PRESIDENT
Name	:	TAREQ IZZAT BECK
Credential	:	DDS
Telephone Number	:	346-289-5765

Provider Enumeration Date	:	09/08/2023
Last Update Date	:	09/08/2023

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