Provider Demographics
NPI:1104485333
Name:BECK, AMANDA MARIE (DDS)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:MARIE
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 1:220 N GLOCHESKI DR
Mailing Address - Street 2:
Mailing Address - City:MANISTEE
Mailing Address - State:MI
Mailing Address - Zip Code:49660-2635
Mailing Address - Country:US
Mailing Address - Phone:231-398-9304
Mailing Address - Fax:
Practice Address - Street 1:220 N GLOCHESKI DR
Practice Address - Street 2:
Practice Address - City:MANISTEE
Practice Address - State:MI
Practice Address - Zip Code:49660-2635
Practice Address - Country:US
Practice Address - Phone:231-398-9305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-11
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29510006581223G0001X
MI29016004551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice