Provider Demographics
NPI:1215377148
Name:BECKER, CHRISTIAN J (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:J
Last Name:BECKER
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 1:1339 N SUMTER BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34286-8072
Mailing Address - Country:US
Mailing Address - Phone:941-876-4023
Mailing Address - Fax:941-876-4369
Practice Address - Street 1:1339 N SUMTER BLVD
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34286-8072
Practice Address - Country:US
Practice Address - Phone:941-876-4023
Practice Address - Fax:941-876-4369
Is Sole Proprietor?:No
Enumeration Date:2013-06-25
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN20222122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist