Healthcare Provider Details

I. General information

NPI: 1255659876
Provider Name (Legal Business Name): JASON THOMAS BECK D.D.S., M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2010
Last Update Date: 05/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7030 SANGER AVE STE 100
WACO TX
76712
US

IV. Provider business mailing address

7030 SANGER AVE STE 100
WACO TX
76712
US

V. Phone/Fax

Practice location:
  • Phone: 254-751-1171
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number22020
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: