Provider Demographics
NPI:1124198106
Name:BECK, WENDELL GENE (DMD)
Entity Type:Individual
Prefix:DR
First Name:WENDELL
Middle Name:GENE
Last Name:BECK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SWEET TOOTH FAMILY DENTAL
Mailing Address - Street 2:211 14TH AVE E
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98112
Mailing Address - Country:US
Mailing Address - Phone:206-323-1436
Mailing Address - Fax:206-324-0456
Practice Address - Street 1:SWEET TOOTH FAMILY DENTAL
Practice Address - Street 2:211 14TH AVE E
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98112
Practice Address - Country:US
Practice Address - Phone:206-323-1436
Practice Address - Fax:206-324-0456
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000092871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5042015Medicaid