Provider Demographics
NPI:1376685925
Name:BECKER, HARRY ROBERT (DDS)
Entity Type:Individual
Prefix:
First Name:HARRY
Middle Name:ROBERT
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 1:1995 ZINFANDEL DR
Mailing Address - Street 2:SUITE 106
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-2862
Mailing Address - Country:US
Mailing Address - Phone:916-852-9122
Mailing Address - Fax:916-852-1321
Practice Address - Street 1:1995 ZINFANDEL DR
Practice Address - Street 2:SUITE 106
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95670-2862
Practice Address - Country:US
Practice Address - Phone:916-852-9122
Practice Address - Fax:916-852-1321
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD221340174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADSO221340Medicare ID - Type UnspecifiedPROVIDER NUMBER
CAU62132Medicare UPIN