Provider Demographics
NPI:1952488322
Name:BECKER, STANLEY S (DDS)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:S
Last Name:BECKER
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 1:7768 LAKESIDE BLVD APT 541
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-6298
Mailing Address - Country:US
Mailing Address - Phone:561-487-7050
Mailing Address - Fax:718-448-8901
Practice Address - Street 1:1146 HYLAN BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-2031
Practice Address - Country:US
Practice Address - Phone:718-273-5558
Practice Address - Fax:718-448-8901
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022678122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist