Provider Demographics
NPI:1982718037
Name:BECKER, WILLIAM S (DDS)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:S
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 1:402 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:ANOKA
Mailing Address - State:MN
Mailing Address - Zip Code:55303-2516
Mailing Address - Country:US
Mailing Address - Phone:763-427-2740
Mailing Address - Fax:763-427-1363
Practice Address - Street 1:402 MONROE ST
Practice Address - Street 2:
Practice Address - City:ANOKA
Practice Address - State:MN
Practice Address - Zip Code:55303-2516
Practice Address - Country:US
Practice Address - Phone:763-427-2740
Practice Address - Fax:763-427-1363
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND110621223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics