Healthcare Provider Details

I. General information

NPI: 1346271764
Provider Name (Legal Business Name): RICHARD LESLIE BECK DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 01/10/2023
Certification Date: 01/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 E 84TH DRIVE SUITE 106
MERRILLVILLE IN
46410-6454
US

IV. Provider business mailing address

233 E 84TH DRIVE SUITE 106
MERRILLVILLE IN
46410-6454
US

V. Phone/Fax

Practice location:
  • Phone: 219-736-2309
  • Fax: 219-736-2328
Mailing address:
  • Phone: 219-736-2309
  • Fax: 219-736-2328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12009654A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number12009654A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: