Provider Demographics
NPI:1235190430
Name:BECKER, LAWRENCE E (DMD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:E
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 1:134 MINEOLA BLVD
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-3959
Mailing Address - Country:US
Mailing Address - Phone:516-294-9696
Mailing Address - Fax:516-294-3531
Practice Address - Street 1:134 MINEOLA BLVD
Practice Address - Street 2:3RD FLOOR
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-3959
Practice Address - Country:US
Practice Address - Phone:516-294-9696
Practice Address - Fax:516-294-3531
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0428281223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU48629Medicare UPIN
NYD9C931Medicare PIN