Provider Demographics
NPI:1437553591
Name:BECKER DENTAL AND ASSOCIATES
Entity Type:Organization
Organization Name:BECKER DENTAL AND ASSOCIATES
Other - Org Name:BECKER DENTAL AND ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:BECKER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-827-9100
Mailing Address - Street 1:2454 E DEMPSTER ST
Mailing Address - Street 2:SUITE 416
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-5315
Mailing Address - Country:US
Mailing Address - Phone:847-827-9100
Mailing Address - Fax:847-827-1400
Practice Address - Street 1:2454 E DEMPSTER ST
Practice Address - Street 2:SUITE 416
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-5315
Practice Address - Country:US
Practice Address - Phone:847-827-9100
Practice Address - Fax:847-827-1400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-20
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190252131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty