Provider Demographics
NPI:1174919302
Name:BECKER, ODESSA JANE (RDH)
Entity type:Individual
Prefix:MISS
First Name:ODESSA
Middle Name:JANE
Last Name:BECKER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 PRESCOTT ST
Mailing Address - Street 2:APT 16
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-6166
Mailing Address - Country:US
Mailing Address - Phone:603-493-8033
Mailing Address - Fax:
Practice Address - Street 1:102 PLEASANT ST
Practice Address - Street 2:SUITE 3
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-3863
Practice Address - Country:US
Practice Address - Phone:603-493-8033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-14
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH03201124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist