Provider Demographics
NPI:1285740878
Name:BRADLEY D BECKER DDS PA
Entity type:Organization
Organization Name:BRADLEY D BECKER DDS PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:BECKER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:479-646-0706
Mailing Address - Street 1:3600 OLD GREENWOOD RD
Mailing Address - Street 2:STE 2
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-5929
Mailing Address - Country:US
Mailing Address - Phone:479-646-0706
Mailing Address - Fax:479-646-0502
Practice Address - Street 1:3600 OLD GREENWOOD RD
Practice Address - Street 2:STE 2
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-5929
Practice Address - Country:US
Practice Address - Phone:479-646-0706
Practice Address - Fax:479-646-0502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR35031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5Y750OtherBCBS
AR1821165OtherUNITED CONCORDIA
AR=========OtherMUNICIPAL HELATH
AR=========OtherPREMIER CARE (SPARKS)
AR=========OtherMETLIFE
AR=========OtherDELTA DENTAL
AR1821165OtherUNITED CONCORDIA