Provider Demographics
NPI:1295898799
Name:BECK, JIM K (DDS)
Entity type:Individual
Prefix:DR
First Name:JIM
Middle Name:K
Last Name:BECK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1619 N GREENWOOD ST
Mailing Address - Street 2:SUITE 308
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-2644
Mailing Address - Country:US
Mailing Address - Phone:719-544-0901
Mailing Address - Fax:719-544-0625
Practice Address - Street 1:1619 N GREENWOOD ST
Practice Address - Street 2:SUITE 308
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-2644
Practice Address - Country:US
Practice Address - Phone:719-544-0901
Practice Address - Fax:719-544-0625
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
COHD1049521223G0001X, 1223S0112X, 332B00000X, 1223X2210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X2210XDental ProvidersDentistOrofacial PainGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral Practice
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty