Provider Demographics
NPI:1114145976
Name:BECKER, ELLIOT AARON (DDS)
Entity Type:Individual
Prefix:MISS
First Name:ELLIOT
Middle Name:AARON
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 1:1349 47TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-2612
Mailing Address - Country:US
Mailing Address - Phone:718-438-3816
Mailing Address - Fax:718-438-3991
Practice Address - Street 1:1349 47TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-2612
Practice Address - Country:US
Practice Address - Phone:718-438-3816
Practice Address - Fax:718-438-3991
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0279921223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00948265Medicaid