Provider Demographics
NPI:1376647859
Name:J. R. BEK, D.D.S., P.C.
Entity Type:Organization
Organization Name:J. R. BEK, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:RANDALL
Authorized Official - Last Name:BEK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:757-426-6151
Mailing Address - Street 1:1767 PRINCESS ANNE RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-3835
Mailing Address - Country:US
Mailing Address - Phone:757-426-6151
Mailing Address - Fax:757-426-6235
Practice Address - Street 1:1767 PRINCESS ANNE RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-3835
Practice Address - Country:US
Practice Address - Phone:757-426-6151
Practice Address - Fax:757-426-6235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010072561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty