Provider Demographics
NPI:1417979972
Name:BECKER, EDWARD J (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:J
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 1:15600 WASHINGTON AVE
Mailing Address - Street 2:STE. A
Mailing Address - City:SAN LORENZO
Mailing Address - State:CA
Mailing Address - Zip Code:94580-1467
Mailing Address - Country:US
Mailing Address - Phone:510-276-7124
Mailing Address - Fax:510-276-2132
Practice Address - Street 1:15600 WASHINGTON AVE
Practice Address - Street 2:STE. A
Practice Address - City:SAN LORENZO
Practice Address - State:CA
Practice Address - Zip Code:94580-1467
Practice Address - Country:US
Practice Address - Phone:510-276-7124
Practice Address - Fax:510-276-2132
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14549122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist