MEDICARE: DR. GARY LEIGH 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	30015281	OH

General Provider Information

NPI Number	:	1841285244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY LEIGH BECKER DDS

Provider Business Mailing Address
First Line	:	7809 N DIXIE DR
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45414-2719
Country	:	US
Telephone Number	:	937-890-5063
Fax Number	:	937-890-5133

Provider Business Practice Location Address
First Line	:	7809 N DIXIE DR
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45414-2719
Country	:	US
Telephone Number	:	937-890-5063
Fax Number	:	937-890-5133

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

Provider Enumeration Date	:	09/13/2005
Last Update Date	:	07/08/2007

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