Provider Demographics
NPI:1760591846
Name:BECK, MICHAEL EARL (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:EARL
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 1:3435 SPRING ST STE 2
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-2142
Mailing Address - Country:US
Mailing Address - Phone:563-355-7749
Mailing Address - Fax:563-355-9884
Practice Address - Street 1:3435 SPRING ST
Practice Address - Street 2:STE 2
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-2142
Practice Address - Country:US
Practice Address - Phone:563-355-7749
Practice Address - Fax:563-355-9884
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA65521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice