MEDICARE: GREGORY M BECKER DDS LLC

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	2890	AZ

General Provider Information

NPI Number	:	1710251913
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREGORY M BECKER DDS LLC

Provider Business Mailing Address
First Line	:	13980 N 67TH AVE STE 2
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85306-3715
Country	:	US
Telephone Number	:	623-979-9454
Fax Number	:	623-979-9474

Provider Business Practice Location Address
First Line	:	13980 N 67TH AVE STE 2
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85306-3715
Country	:	US
Telephone Number	:	623-979-9454
Fax Number	:	623-979-9474

Authorized Official
Title or Position	:	MEMBER
Name	:	DR. GREGORY M BECKER
Credential	:	DDS
Telephone Number	:	623-979-9454

Provider Enumeration Date	:	03/06/2012
Last Update Date	:	03/06/2012

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