MEDICARE: MICHAEL DAMIAN BECKER D.M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	0401411263	VA
2	122300000X	Dentist	8569	KY

General Provider Information

NPI Number	:	1023080710
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL DAMIAN BECKER D.M.D

Provider Business Mailing Address
First Line	:	11518 SARATOGA CLUB RD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40299-4374
Country	:	US
Telephone Number	:	502-648-2495
Fax Number	:

Provider Business Practice Location Address
First Line	:	119 TOPFIELD RD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40229-4462
Country	:	US
Telephone Number	:	502-957-4408
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2006
Last Update Date	:	01/17/2013

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