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General NPI Number Information
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NPI Number | 1437553591
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Entity Type | Organization
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Legal Business Name | BECKER DENTAL AND ASSOCIATES
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Dates
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Enumeration Date | 10/20/2014
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Last Update Date | 10/20/2014
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Provider Practice Location Address
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Address Line | 2454 E DEMPSTER ST SUITE 416
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City | DES PLAINES
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State | IL
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Zip | 60016-5315
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Country | US
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Telephone | 847-827-9100
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Fax | 847-827-1400
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Provider Business Mailing Address
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Address Line | 2454 E DEMPSTER ST SUITE 416
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City | DES PLAINES
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State | IL
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Zip | 60016-5315
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Country | US
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Telephone | 847-827-9100
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Fax | 847-827-1400
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Authorized Official
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Title or Position | OWNER
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Name | MR. BORIS BECKER
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Credential | D.D.S
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Telephone | 847-827-9100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019025213
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License Number State | IL
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