MEDICARE: JOHN MICHAEL 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	6030	KY

General Provider Information

NPI Number	:	1073716130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN MICHAEL BECKER D.M.D.

Provider Business Mailing Address
First Line	:	1463 S FORT THOMAS AVE
Second Line	:
City	:	FORT THOMAS
State	:	KY
Zip	:	41075-2453
Country	:	US
Telephone Number	:	859-781-4000
Fax Number	:	859-781-4104

Provider Business Practice Location Address
First Line	:	1463 S FORT THOMAS AVE
Second Line	:
City	:	FORT THOMAS
State	:	KY
Zip	:	41075-2453
Country	:	US
Telephone Number	:	859-781-4000
Fax Number	:	859-781-4104

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

Provider Enumeration Date	:	06/07/2007
Last Update Date	:	07/08/2007

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