Provider Demographics
NPI:1952469280
Name:BECICKA, PATRICK GARY (DDS)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:GARY
Last Name:BECICKA
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 1:5047 JASON AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBERTVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55301-9688
Mailing Address - Country:US
Mailing Address - Phone:763-497-8165
Mailing Address - Fax:763-497-8162
Practice Address - Street 1:5047 JASON AVE NE
Practice Address - Street 2:
Practice Address - City:ALBERTVILLE
Practice Address - State:MN
Practice Address - Zip Code:55301-9688
Practice Address - Country:US
Practice Address - Phone:763-497-8165
Practice Address - Fax:763-497-8162
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND109741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice