Provider Demographics
NPI:1992822811
Name:BECK, ROGER DUANE (DDS)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:DUANE
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 1:3470 E MERIDIAN PARK LOOP
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7294
Mailing Address - Country:US
Mailing Address - Phone:907-373-8684
Mailing Address - Fax:907-373-8465
Practice Address - Street 1:3470 E MERIDIAN PARK LOOP
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7294
Practice Address - Country:US
Practice Address - Phone:907-373-8684
Practice Address - Fax:907-373-8465
Is Sole Proprietor?:No
Enumeration Date:2007-03-24
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK9241223P0221X
AK1011223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1003811Medicaid
AK1583808Medicaid