Provider Demographics
NPI:1689982324
Name:DOUG BECKER DDS PC
Entity Type:Organization
Organization Name:DOUG BECKER DDS PC
Other - Org Name:BLANCO DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:BECKER
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:830-833-2200
Mailing Address - Street 1:2222 N HIGHWAY 281
Mailing Address - Street 2:
Mailing Address - City:BLANCO
Mailing Address - State:TX
Mailing Address - Zip Code:78606-5356
Mailing Address - Country:US
Mailing Address - Phone:830-833-2200
Mailing Address - Fax:830-833-2203
Practice Address - Street 1:2222 N HIGHWAY 281
Practice Address - Street 2:
Practice Address - City:BLANCO
Practice Address - State:TX
Practice Address - Zip Code:78606-5356
Practice Address - Country:US
Practice Address - Phone:830-833-2200
Practice Address - Fax:830-833-2203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-15
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12408261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental