Healthcare Provider Details

I. General information

NPI: 1407389802
Provider Name (Legal Business Name): JONATHAN BEKER DMD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2017
Last Update Date: 06/19/2023
Certification Date: 06/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10972 ALLISONVILLE RD STE 110
FISHERS IN
46038-2639
US

IV. Provider business mailing address

10972 ALLISONVILLE RD STE 110
FISHERS IN
46038-2639
US

V. Phone/Fax

Practice location:
  • Phone: 317-845-7878
  • Fax:
Mailing address:
  • Phone: 317-845-7878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number12013964A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: