Provider Demographics
NPI:1982981312
Name:W GENE BECK JR P.L.L.C
Entity type:Organization
Organization Name:W GENE BECK JR P.L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WENDELL
Authorized Official - Middle Name:GENE
Authorized Official - Last Name:BECK
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:206-579-4119
Mailing Address - Street 1:211 14TH AVE E
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98112-5223
Mailing Address - Country:US
Mailing Address - Phone:206-579-4119
Mailing Address - Fax:
Practice Address - Street 1:211 14TH AVE E
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98112-5223
Practice Address - Country:US
Practice Address - Phone:206-579-4119
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-14
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE9287261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental