Provider Demographics
NPI:1578173910
Name:BECK, KIMBERLY (RDH, BS)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:BECK
Suffix:
Gender:F
Credentials:RDH, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18030 SANDTRAP DR
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34114-7596
Mailing Address - Country:US
Mailing Address - Phone:239-776-8836
Mailing Address - Fax:239-692-9850
Practice Address - Street 1:18030 SANDTRAP DR
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34114-7596
Practice Address - Country:US
Practice Address - Phone:239-776-8836
Practice Address - Fax:239-776-8836
Is Sole Proprietor?:No
Enumeration Date:2020-07-31
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18232124Q00000X
CT006507125J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
No125J00000XDental ProvidersDental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT006507OtherCT DPH LICENSE