Provider Demographics
NPI:1306364112
Name:BECK, NATHAN LUTERU (DDS)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:LUTERU
Last Name:BECK
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 1:625 KEOUGH ST
Mailing Address - Street 2:
Mailing Address - City:BISHOP
Mailing Address - State:CA
Mailing Address - Zip Code:93514-2533
Mailing Address - Country:US
Mailing Address - Phone:760-258-7524
Mailing Address - Fax:
Practice Address - Street 1:625 KEOUGH ST
Practice Address - Street 2:
Practice Address - City:BISHOP
Practice Address - State:CA
Practice Address - Zip Code:93514-2533
Practice Address - Country:US
Practice Address - Phone:760-258-7524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA646181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice