Provider Demographics
NPI:1043517782
Name:BECKER, STANLEY L (DDS)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:L
Last Name:BECKER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 W UNIVERSITY PKWY
Mailing Address - Street 2:SUITE 1R
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21210-3254
Mailing Address - Country:US
Mailing Address - Phone:410-366-0500
Mailing Address - Fax:
Practice Address - Street 1:500 W UNIVERSITY PKWY
Practice Address - Street 2:SUITE 1R
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21210-3254
Practice Address - Country:US
Practice Address - Phone:410-366-0500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-15
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD041341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice