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NPI Code Detail

MEDICARE: W GENE BECK JR P.L.L.C

MEDICARE: W GENE BECK JR P.L.L.C
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
1261QD0000XDental Clinic/CenterDE9287WA

General Provider Information

NPI Number : 1982981312
Entity Type Code : Organization
Provider Name (Legal Business Name) : W GENE BECK JR P.L.L.C
Provider Business Mailing Address
First Line : 211 14TH AVE E
Second Line :
City : SEATTLE
State : WA
Zip : 98112-5223
Country : US
Telephone Number : 206-579-4119
Fax Number :
Provider Business Practice Location Address
First Line : 211 14TH AVE E
Second Line :
City : SEATTLE
State : WA
Zip : 98112-5223
Country : US
Telephone Number : 206-579-4119
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DR. WENDELL GENE BECK JR.
Credential : D.M.D.
Telephone Number : 206-579-4119
Provider Enumeration Date : 11/14/2011
Last Update Date : 11/14/2011

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