Provider Demographics
NPI:1356561195
Name:BECKER, AMY (DDS)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:
Last Name:BECKER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1551 N GREEN ST
Mailing Address - Street 2:SUITE N
Mailing Address - City:BROWNSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46112-8162
Mailing Address - Country:US
Mailing Address - Phone:317-852-5668
Mailing Address - Fax:317-852-9572
Practice Address - Street 1:1551 N GREEN ST
Practice Address - Street 2:SUITE N
Practice Address - City:BROWNSBURG
Practice Address - State:IN
Practice Address - Zip Code:46112-8162
Practice Address - Country:US
Practice Address - Phone:317-852-5668
Practice Address - Fax:317-852-9572
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009747A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist