MEDICARE: STEPHANIE BECKER

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	S-01828	KY

General Provider Information

NPI Number	:	1639745326
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE BECKER

Provider Business Mailing Address
First Line	:	1301 WINCHESTER RD
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40505-4153
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1301 WINCHESTER RD
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40505-4153
Country	:	US
Telephone Number	:	859-518-8215
Fax Number	:

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

Provider Enumeration Date	:	06/02/2021
Last Update Date	:	06/12/2026

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Directions to “ STEPHANIE BECKER ” Practice Location

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