Provider Demographics
NPI:1285648923
Name:MAHER, BECKY S (DDS, MS)
Entity Type:Individual
Prefix:
First Name:BECKY
Middle Name:S
Last Name:MAHER
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 CREST VIEW DR
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016-9366
Mailing Address - Country:US
Mailing Address - Phone:715-381-3600
Mailing Address - Fax:715-381-8124
Practice Address - Street 1:131 CARMICHAEL RD STE 200
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016-8271
Practice Address - Country:US
Practice Address - Phone:715-381-3600
Practice Address - Fax:715-381-8124
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI54661223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI5466OtherDENTAL LICENSE