Provider Demographics
NPI:1336248897
Name:BECK, GARY CYRIL (DDS)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:CYRIL
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 1:645 W FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-3859
Mailing Address - Country:US
Mailing Address - Phone:909-946-3836
Mailing Address - Fax:909-946-1890
Practice Address - Street 1:645 W FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-3859
Practice Address - Country:US
Practice Address - Phone:909-946-3836
Practice Address - Fax:909-946-1890
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA187841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice