Provider Demographics
NPI:1194933036
Name:BECHT, MICHAEL PETER (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:PETER
Last Name:BECHT
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:107 N WATTERSON TRL
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40243-1381
Mailing Address - Country:US
Mailing Address - Phone:502-245-2175
Mailing Address - Fax:502-245-4577
Practice Address - Street 1:107 N WATTERSON TRL
Practice Address - Street 2:SUITE 103
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40243-1381
Practice Address - Country:US
Practice Address - Phone:502-245-2175
Practice Address - Fax:502-245-4577
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY8331223X0400X
KY8368122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist