Megan Becker, MDT – Dental Therapist

Key facts

NPI: 1013395136
Entity type: Individual (NPI type 1)
Primary specialty: Dental Therapist 125J00000X
License: DT58 (MN)
Practice address: 12936 63Rd Ave N
Maple Grove, MN 55369-6001
Phone: (763) 559-3400
NPI assigned: May 8, 2015
Sex: Female
Sole proprietor: No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Al Shifa Dentistry PA Dental Clinic/Center · Maple Grove, MN · NPI 1760703151

NPD (past)

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

State licenses

License	State	Type	Specialty
DT58	MN	MD	Dental Therapist

Practice roles

Organization	Specialty	Status	New patients
Al Shifa Dentistry PA		Past	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Dental Therapist	125J00000X	DT58	MN	Yes

Addresses

Primary practice location

12936 63Rd Ave N
Maple Grove, MN 55369-6001

Mailing address

8196 Shadyview LN N
Maple Grove, MN 55311-1700
Phone (763) 913-9441

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on May 8, 2015.

{
    "created_epoch": "1431043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1431043200000",
    "number": "1013395136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8196 SHADYVIEW LN N",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553111700",
            "telephone_number": "763-913-9441"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12936 63RD AVE N",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553696001",
            "telephone_number": "763-559-3400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BECKER",
        "first_name": "MEGAN",
        "credential": "MDT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-05-08",
        "last_updated": "2015-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "125J00000X",
            "taxonomy_group": "",
            "desc": "Dental Therapist",
            "state": "MN",
            "license": "DT58",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Maple Grove, MN

All providers in Maple Grove, MN · Dental Therapist in Minnesota

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 8, 2015. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.