Healthcare Provider Details

I. General information

NPI: 1588388003
Provider Name (Legal Business Name): BECK DENTAL CENTER, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2022
Last Update Date: 09/28/2022
Certification Date: 09/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 E 84TH DR STE 106
MERRILLVILLE IN
46410-6454
US

IV. Provider business mailing address

233 E 84TH DR STE 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 TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RICHARD BECK
Title or Position: DENTIST
Credential: DDS
Phone: 219-736-2309