Healthcare Provider Details

I. General information

NPI: 1174919302
Provider Name (Legal Business Name): ODESSA JANE BECKER R.D.H.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2015
Last Update Date: 04/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 PLEASANT ST SUITE 3
CONCORD NH
03301-3863
US

IV. Provider business mailing address

29 PRESCOTT ST APT 16
CONCORD NH
03301-6166
US

V. Phone/Fax

Practice location:
  • Phone: 603-493-8033
  • Fax:
Mailing address:
  • Phone: 603-493-8033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number03201
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: