Provider Demographics
NPI:1467664490
Name:BECKER, SCOTT STEVEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:STEVEN
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 1:3046 AVENIDA DE PORTUGAL
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92106-2650
Mailing Address - Country:US
Mailing Address - Phone:619-221-5000
Mailing Address - Fax:619-221-5003
Practice Address - Street 1:3046 AVENIDA DE PORTUGAL
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92106-2650
Practice Address - Country:US
Practice Address - Phone:619-221-5000
Practice Address - Fax:619-221-5003
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA397551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice