Provider Demographics
NPI:1194373621
Name:BECK, KASEEM (DMD)
Entity Type:Individual
Prefix:
First Name:KASEEM
Middle Name:
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 1:5730 MARTIN GROVE DR NW
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-6078
Mailing Address - Country:US
Mailing Address - Phone:770-728-2560
Mailing Address - Fax:
Practice Address - Street 1:GWINNETT FAMILY DENTAL CARE
Practice Address - Street 2:3455 LAWRENCEVILLE HWY
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044
Practice Address - Country:US
Practice Address - Phone:770-921-1115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-28
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN015877122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist