Individual
DR. BRUCE FARRELL BECKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
556 N OAK ROAD, LIGHT HOUSE DENTAL, PLYMOUTH, IN 46563-1664
(574) 936-3921
(574) 936-1010
Mailing address
556 N OAK ROAD, LIGHT HOUSE DENTAL, PLYMOUTH, IN 46563-1664
(574) 936-3921
(574) 936-1010
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12009200
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200151790B
—
IN
Enumeration date
06/26/2008
Last updated
06/26/2008
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