Provider Demographics
NPI:1114084886
Name:BECKER AND GRISAR DDS LTD
Entity Type:Organization
Organization Name:BECKER AND GRISAR DDS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:P
Authorized Official - Last Name:BECKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-377-4130
Mailing Address - Street 1:1515 WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:WI
Mailing Address - Zip Code:53024-1962
Mailing Address - Country:US
Mailing Address - Phone:262-377-4130
Mailing Address - Fax:262-377-4599
Practice Address - Street 1:1515 WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:WI
Practice Address - Zip Code:53024-1962
Practice Address - Country:US
Practice Address - Phone:262-377-4130
Practice Address - Fax:262-377-4599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty