=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376650655
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STROHECKER - BECKETT ORTHODONTICS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/24/2006
-----------------------------------------------------
Last Update Date | 01/23/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 456 E. HANCOCK ST
-----------------------------------------------------
City | LANSDALE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19446
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-855-7717
-----------------------------------------------------
Fax | 215-368-0937
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 456 E. HANCOCK ST
-----------------------------------------------------
City | LANSDALE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19446
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-855-7717
-----------------------------------------------------
Fax | 215-368-0937
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. SANDY STROHECKER BECKETT
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 215-855-7717
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number | DS029884L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number | DS-029884-L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------