Provider Demographics
NPI:1073990560
Name:BECK, DANA
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:BECK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3220 E BASELINE RD
Mailing Address - Street 2:112
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85042-7115
Mailing Address - Country:US
Mailing Address - Phone:602-437-2225
Mailing Address - Fax:
Practice Address - Street 1:3220 E BASELINE RD
Practice Address - Street 2:112
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85042-7115
Practice Address - Country:US
Practice Address - Phone:602-437-2225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-04
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-15253174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist