MEDICARE: BRADLEY D BECKER DDS PA

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	3503	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5Y750	OTHER	AR	BCBS
2	1821165	OTHER	AR	UNITED CONCORDIA

General Provider Information

NPI Number	:	1285740878
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRADLEY D BECKER DDS PA

Provider Business Mailing Address
First Line	:	3600 OLD GREENWOOD RD
Second Line	:	STE 2
City	:	FORT SMITH
State	:	AR
Zip	:	72903-5929
Country	:	US
Telephone Number	:	479-646-0706
Fax Number	:	479-646-0502

Provider Business Practice Location Address
First Line	:	3600 OLD GREENWOOD RD
Second Line	:	STE 2
City	:	FORT SMITH
State	:	AR
Zip	:	72903-5929
Country	:	US
Telephone Number	:	479-646-0706
Fax Number	:	479-646-0502

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BRADLEY DAVID BECKER
Credential	:	DDS
Telephone Number	:	479-646-0706

Provider Enumeration Date	:	08/23/2006
Last Update Date	:	08/22/2020

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