Provider Demographics
NPI:1265718068
Name:MICHELE ROGERS BECK D.M.D. P.S.C.
Entity type:Organization
Organization Name:MICHELE ROGERS BECK D.M.D. P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:ROGERS
Authorized Official - Last Name:BECK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:859-261-5852
Mailing Address - Street 1:640 SCOTT ST
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41011-2416
Mailing Address - Country:US
Mailing Address - Phone:859-261-5852
Mailing Address - Fax:859-261-5853
Practice Address - Street 1:640 SCOTT ST
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:KY
Practice Address - Zip Code:41011-2416
Practice Address - Country:US
Practice Address - Phone:859-261-5852
Practice Address - Fax:859-261-5853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-25
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY7746261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1649332503OtherINDIVIDUAL NPI
KY60001815Medicaid