Provider Demographics
NPI:1396897294
Name:BECKER, WENDY F (DDS)
Entity type:Individual
Prefix:DR
First Name:WENDY
Middle Name:F
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 1:850 NO MAIN STREET EXTENSION
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492
Mailing Address - Country:US
Mailing Address - Phone:203-269-4249
Mailing Address - Fax:203-294-4444
Practice Address - Street 1:850 NO MAIN STREET EXTENSION
Practice Address - Street 2:SUITE 2B
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492
Practice Address - Country:US
Practice Address - Phone:203-269-4249
Practice Address - Fax:203-294-4444
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT85571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice