Provider Demographics
NPI:1487098596
Name:BECKER, TODD ALAN (DDS)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:ALAN
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 1:403 W PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAMPTON
Mailing Address - State:IA
Mailing Address - Zip Code:50659-1149
Mailing Address - Country:US
Mailing Address - Phone:641-394-4831
Mailing Address - Fax:
Practice Address - Street 1:403 W PROSPECT ST
Practice Address - Street 2:
Practice Address - City:NEW HAMPTON
Practice Address - State:IA
Practice Address - Zip Code:50659-1149
Practice Address - Country:US
Practice Address - Phone:641-394-4831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-18
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06553122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist