MEDICARE: MR. GERALD L BECKER DDS

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	1223G0001X	General Practice Dentistry		WA

General Provider Information

NPI Number	:	1275502809
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GERALD L BECKER DDS

Provider Business Mailing Address
First Line	:	809 NW 165TH ST
Second Line	:
City	:	SHORELINE
State	:	WA
Zip	:	98177-3732
Country	:	US
Telephone Number	:	206-546-9501
Fax Number	:	206-546-2821

Provider Business Practice Location Address
First Line	:	715 N 182ND ST
Second Line	:	SUITE 401
City	:	SHORELINE
State	:	WA
Zip	:	98133-4402
Country	:	US
Telephone Number	:	206-542-4848
Fax Number	:	206-546-2821

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

Provider Enumeration Date	:	03/16/2006
Last Update Date	:	07/08/2007

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