Provider Demographics
NPI:1770156796
Name:BECK, KRISTIN (DDS)
Entity type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:
Last Name:BECK
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 1:4606 AMESBURY DR APT 429
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-4845
Mailing Address - Country:US
Mailing Address - Phone:308-352-6425
Mailing Address - Fax:
Practice Address - Street 1:51 N FM 548 UNIT 201
Practice Address - Street 2:
Practice Address - City:FORNEY
Practice Address - State:TX
Practice Address - Zip Code:75126-4161
Practice Address - Country:US
Practice Address - Phone:972-810-1782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX375501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice