Provider Demographics
NPI:1841285244
Name:BECKER, GARY LEIGH (DDS)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:LEIGH
Last Name:BECKER
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 1:7809 N DIXIE DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45414-2719
Mailing Address - Country:US
Mailing Address - Phone:937-890-5063
Mailing Address - Fax:937-890-5133
Practice Address - Street 1:7809 N DIXIE DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45414-2719
Practice Address - Country:US
Practice Address - Phone:937-890-5063
Practice Address - Fax:937-890-5133
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300152811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice