Provider Demographics
NPI:1700895364
Name:BECK, MICHAEL DEWAIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DEWAIN
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 1:3510 MATTYE MAYE DR
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77503-2710
Mailing Address - Country:US
Mailing Address - Phone:713-477-2917
Mailing Address - Fax:
Practice Address - Street 1:1824 STRAWBERRY RD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77502-2610
Practice Address - Country:US
Practice Address - Phone:713-477-3858
Practice Address - Fax:713-477-0187
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX97611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice