Healthcare Provider Details

I. General information

NPI: 1881687267
Provider Name (Legal Business Name): ROBERT W BECK DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 08/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6900 ALDEN DR
FE WARREN AFB WY
82005-3906
US

IV. Provider business mailing address

PO BOX 6014
LINCOLN NE
68506-0014
US

V. Phone/Fax

Practice location:
  • Phone: 307-773-5624
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number4887
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: