Healthcare Provider Details

I. General information

NPI: 1912646027
Provider Name (Legal Business Name): SARAH BECK DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2022
Last Update Date: 11/06/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 BROADWAY AVE S
ROCHESTER MN
55904-7960
US

IV. Provider business mailing address

1705 BROADWAY AVE S STE B
ROCHESTER MN
55904-7960
US

V. Phone/Fax

Practice location:
  • Phone: 507-288-0102
  • Fax:
Mailing address:
  • Phone: 507-288-0102
  • Fax: 319-335-7451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberRES-30643
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberD15045
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: