Provider Demographics
NPI:1093596637
Name:BECK PASSAMANO DENTAL GROUP
Entity Type:Organization
Organization Name:BECK PASSAMANO DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BECK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-396-3803
Mailing Address - Street 1:14982 SAND CANYON AVE
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-2106
Mailing Address - Country:US
Mailing Address - Phone:949-396-3803
Mailing Address - Fax:
Practice Address - Street 1:14982 SAND CANYON AVE
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-2106
Practice Address - Country:US
Practice Address - Phone:949-396-3803
Practice Address - Fax:949-572-7708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-10
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental