Healthcare Provider Details

I. General information

NPI: 1295898799
Provider Name (Legal Business Name): JIM K BECK DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 10/06/2023
Certification Date: 10/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1619 N GREENWOOD ST SUITE 308
PUEBLO CO
81003-2644
US

IV. Provider business mailing address

1619 N GREENWOOD ST SUITE 308
PUEBLO CO
81003-2644
US

V. Phone/Fax

Practice location:
  • Phone: 719-544-0901
  • Fax: 719-544-0625
Mailing address:
  • Phone: 719-544-0901
  • Fax: 719-544-0625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberHD104952
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberHD104952
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberHD104952
License Number StateCO
# 4
Primary TaxonomyY
Taxonomy Code1223X2210X
TaxonomyOrofacial Pain Dentistry
License NumberHD104952
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: