Provider Demographics
NPI:1487716742
Name:BECKER, JOSEPH GERARD (DDS)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:GERARD
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 1:1008 12TH STREET SE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55904-5030
Mailing Address - Country:US
Mailing Address - Phone:507-282-6448
Mailing Address - Fax:507-287-8846
Practice Address - Street 1:1008 12TH STREET SE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55904-5030
Practice Address - Country:US
Practice Address - Phone:507-282-6448
Practice Address - Fax:507-287-8846
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNMN9567122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist