Provider Demographics
NPI:1518171008
Name:BECK, GEORGE HENRY (DDS)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:HENRY
Last Name:BECK
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 1:1700 N SALEM AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81001
Mailing Address - Country:US
Mailing Address - Phone:719-545-9936
Mailing Address - Fax:719-545-0058
Practice Address - Street 1:1700 N SALEM AVE
Practice Address - Street 2:SUITE A
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81001
Practice Address - Country:US
Practice Address - Phone:719-545-9936
Practice Address - Fax:719-545-0058
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO323122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist