Provider Demographics
NPI:1750685327
Name:G DOUGLAS BECK DDS PS
Entity Type:Organization
Organization Name:G DOUGLAS BECK DDS PS
Other - Org Name:WILDWOOD DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:BECK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:425-368-0611
Mailing Address - Street 1:1617 183RD ST SE STE 1
Mailing Address - Street 2:
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-6812
Mailing Address - Country:US
Mailing Address - Phone:425-368-0600
Mailing Address - Fax:425-368-0690
Practice Address - Street 1:1617 183RD ST SE STE 1
Practice Address - Street 2:
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-6812
Practice Address - Country:US
Practice Address - Phone:425-368-0600
Practice Address - Fax:425-368-0690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-22
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE 0049011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty