Provider Demographics
NPI:1568645687
Name:BECK, TINA M (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:TINA
Middle Name:M
Last Name:BECK
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10672 WEXFORD ST
Mailing Address - Street 2:STE 220
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-3969
Mailing Address - Country:US
Mailing Address - Phone:858-635-6700
Mailing Address - Fax:
Practice Address - Street 1:10672 WEXFORD ST
Practice Address - Street 2:STE 220
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-3969
Practice Address - Country:US
Practice Address - Phone:858-635-6700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-12
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA591851223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics