Provider Demographics
NPI:1831284850
Name:BECKER, KATHY J (DMD)
Entity Type:Individual
Prefix:DR
First Name:KATHY
Middle Name:J
Last Name:BECKER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:KATHY
Other - Middle Name:J
Other - Last Name:GURSKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:601 E LANCASTER AVE
Mailing Address - Street 2:
Mailing Address - City:SHILLINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19607-1366
Mailing Address - Country:US
Mailing Address - Phone:610-796-2120
Mailing Address - Fax:
Practice Address - Street 1:601 E LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:SHILLINGTON
Practice Address - State:PA
Practice Address - Zip Code:19607-1366
Practice Address - Country:US
Practice Address - Phone:610-796-2120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS028217L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice