Provider Demographics
NPI:1225292857
Name:BECKER, VICKI LYNN (DDS)
Entity Type:Individual
Prefix:DR
First Name:VICKI
Middle Name:LYNN
Last Name:BECKER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16860 OAK PARK AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-2761
Mailing Address - Country:US
Mailing Address - Phone:708-532-4363
Mailing Address - Fax:708-532-0549
Practice Address - Street 1:16860 OAK PARK AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-2761
Practice Address - Country:US
Practice Address - Phone:708-532-4363
Practice Address - Fax:708-532-0549
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-13
Last Update Date:2008-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0201631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice