Provider Demographics
NPI:1275502809
Name:BECKER, GERALD L (DDS)
Entity Type:Individual
Prefix:MR
First Name:GERALD
Middle Name:L
Last Name:BECKER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 NW 165TH ST
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98177-3732
Mailing Address - Country:US
Mailing Address - Phone:206-546-9501
Mailing Address - Fax:206-546-2821
Practice Address - Street 1:715 N 182ND ST
Practice Address - Street 2:SUITE 401
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-4402
Practice Address - Country:US
Practice Address - Phone:206-542-4848
Practice Address - Fax:206-546-2821
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice