Basic Information
Provider Information
NPI: 1346382769
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BECKER
FirstName: ARNOLD
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: DDS
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4955 VAN NUYS BLVD
Address2: SUITE 518
City: SHERMAN OAKS
State: CA
PostalCode: 91403
CountryCode: US
TelephoneNumber: 8187838891
FaxNumber: 8187832648
Practice Location
Address1: 4955 VAN NUYS BLVD
Address2: SUITE 518
City: SHERMAN OAKS
State: CA
PostalCode: 91403
CountryCode: US
TelephoneNumber: 8187838891
FaxNumber: 8187832648
Other Information
ProviderEnumerationDate: 02/13/2007
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1223G0001X18785CAY Dental ProvidersDentistGeneral Practice

No ID Information.


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