MEDICARE: RUSSELL P BECKETT D.D.S.

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	12007134	IN

General Provider Information

NPI Number	:	1093832875
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUSSELL P BECKETT D.D.S.

Provider Business Mailing Address
First Line	:	1520 WASHINGTON ST
Second Line	:
City	:	NEW CASTLE
State	:	IN
Zip	:	47362-4355
Country	:	US
Telephone Number	:	765-521-0390
Fax Number	:	765-529-3218

Provider Business Practice Location Address
First Line	:	1520 WASHINGTON ST
Second Line	:
City	:	NEW CASTLE
State	:	IN
Zip	:	47362-4355
Country	:	US
Telephone Number	:	765-521-0390
Fax Number	:	765-529-3218

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

Provider Enumeration Date	:	03/25/2007
Last Update Date	:	07/08/2007

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Directions to “ RUSSELL P BECKETT D.D.S.” Practice Location

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