Provider Demographics
NPI:1013019942
Name:BECKER, MARINA E (DMD)
Entity Type:Individual
Prefix:
First Name:MARINA
Middle Name:E
Last Name:BECKER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 QUINT AVENUE
Mailing Address - Street 2:APT #18
Mailing Address - City:ALLSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02134-2549
Mailing Address - Country:US
Mailing Address - Phone:617-642-7932
Mailing Address - Fax:617-782-3298
Practice Address - Street 1:60 ROGERS STREET
Practice Address - Street 2:SUITE # 1A
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-5070
Practice Address - Country:US
Practice Address - Phone:603-669-3680
Practice Address - Fax:603-668-8310
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3448122300000X
MA20910122300000X
ME3731122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist