Healthcare Provider Details

I. General information

NPI: 1487632139
Provider Name (Legal Business Name): THOMAS DEAN BECKER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 04/25/2023
Certification Date: 04/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 28TH ST
WEST DES MOINES IA
50266-1430
US

IV. Provider business mailing address

1450 28TH ST
WEST DES MOINES IA
50266-1430
US

V. Phone/Fax

Practice location:
  • Phone: 515-224-4455
  • Fax: 515-224-4040
Mailing address:
  • Phone: 515-224-4455
  • Fax: 515-224-4040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number2005026472
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: