Healthcare Provider Details

I. General information

NPI: 1689642308
Provider Name (Legal Business Name): JULIE BECKER, DDS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 04/13/2022
Certification Date: 04/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3820 S FREMONT AVE
SPRINGFIELD MO
65804-6503
US

IV. Provider business mailing address

3820 S FREMONT AVE
SPRINGFIELD MO
65804-6503
US

V. Phone/Fax

Practice location:
  • Phone: 417-882-0948
  • Fax: 417-882-7548
Mailing address:
  • Phone: 417-882-0948
  • Fax: 417-882-7548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: MELVINA TUCKER
Title or Position: OFFICE MANAGER
Credential:
Phone: 417-882-0948