Provider Demographics
NPI:1144577628
Name:BECKER, AUTUMN LEIGH-ANN (DMD)
Entity Type:Individual
Prefix:DR
First Name:AUTUMN
Middle Name:LEIGH-ANN
Last Name:BECKER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:AUTUMN
Other - Middle Name:LEIGH-ANN
Other - Last Name:EDWARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:UNIT 21414
Mailing Address - Street 2:BOX 3530
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09705
Mailing Address - Country:US
Mailing Address - Phone:314-566-5328
Mailing Address - Fax:
Practice Address - Street 1:AVENUE D'OSLO, BLDG 401
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09705
Practice Address - Country:US
Practice Address - Phone:314-566-5328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-14
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS608711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice