Healthcare Provider Details

I. General information

NPI: 1285648923
Provider Name (Legal Business Name): BECKY S. MAHER D.D.S., M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 05/26/2022
Certification Date: 03/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 CARMICHAEL RD STE 200
HUDSON WI
54016-8271
US

IV. Provider business mailing address

1200 CREST VIEW DR
HUDSON WI
54016-9366
US

V. Phone/Fax

Practice location:
  • Phone: 715-381-3600
  • Fax: 715-381-8124
Mailing address:
  • Phone: 715-381-3600
  • Fax: 715-381-8124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number5466
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: