Healthcare Provider Details

I. General information

NPI: 1164487328
Provider Name (Legal Business Name): DRS BECK & BECKER SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 PARK AVE.
COLUMBUS WI
53925
US

IV. Provider business mailing address

PO BOX 163
COLUMBUS WI
53925
US

V. Phone/Fax

Practice location:
  • Phone: 920-623-2340
  • Fax: 920-623-2765
Mailing address:
  • Phone: 920-623-2340
  • Fax: 920-623-2765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number5000599
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number5000598
License Number StateWI

VIII. Authorized Official

Name: DR. JAMES M BECK
Title or Position: PARTNER
Credential: DDS
Phone: 920-623-2340