Provider Demographics
NPI:1396810404
Name:BECKEL, BRADLY T (DDS)
Entity type:Individual
Prefix:DR
First Name:BRADLY
Middle Name:T
Last Name:BECKEL
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 1:5282 MEDICAL DRIVE
Mailing Address - Street 2:SUITE 440
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229
Mailing Address - Country:US
Mailing Address - Phone:210-614-3300
Mailing Address - Fax:210-614-3636
Practice Address - Street 1:5282 MEDICAL DRIVE
Practice Address - Street 2:SUITE 440
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229
Practice Address - Country:US
Practice Address - Phone:210-614-3300
Practice Address - Fax:210-614-3636
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19436122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist