Provider Demographics
NPI:1992887467
Name:STACY BECKER, DDS, LLC
Entity type:Organization
Organization Name:STACY BECKER, DDS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:STACY
Authorized Official - Middle Name:ELAINE BECKER
Authorized Official - Last Name:OCHOA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:636-461-2255
Mailing Address - Street 1:1280 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:IMPERIAL
Mailing Address - State:MO
Mailing Address - Zip Code:63052-3861
Mailing Address - Country:US
Mailing Address - Phone:636-461-2255
Mailing Address - Fax:636-461-0401
Practice Address - Street 1:1280 MAIN ST
Practice Address - Street 2:
Practice Address - City:IMPERIAL
Practice Address - State:MO
Practice Address - Zip Code:63052-3861
Practice Address - Country:US
Practice Address - Phone:636-461-2255
Practice Address - Fax:636-461-0401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002011129122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty