MEDICARE: BECKS COMMON DENTAL PLLC

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1346725694
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BECKS COMMON DENTAL PLLC

Provider Business Mailing Address
First Line	:	939 W NORTH AVE STE 890
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60642-8683
Country	:	US
Telephone Number	:	312-642-3370
Fax Number	:	312-803-0888

Provider Business Practice Location Address
First Line	:	16560 RR 620
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78681-5802
Country	:	US
Telephone Number	:	512-488-9588
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MARK MORRIS
Credential	:	DMD
Telephone Number	:	312-642-3370

Provider Enumeration Date	:	10/02/2018
Last Update Date	:	10/02/2018

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Directions to “BECKS COMMON DENTAL PLLC ” Practice Location

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