Provider Demographics
NPI:1417034067
Name:BECK, THEODORE P (DMD)
Entity Type:Individual
Prefix:
First Name:THEODORE
Middle Name:P
Last Name:BECK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 W LYNDALE AVE
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-2825
Mailing Address - Country:US
Mailing Address - Phone:406-443-6464
Mailing Address - Fax:406-443-0465
Practice Address - Street 1:227 W LYNDALE AVE
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-2825
Practice Address - Country:US
Practice Address - Phone:406-443-6464
Practice Address - Fax:406-443-0465
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT15971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0111452Medicaid