Jonathan Avery Beck, DDS
Individual provider Active NPI Dentist · Silver City, NM
NPI 1104189893 · NPPES record last updated Jun 19, 2012
Key facts
- NPI
- 1104189893
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- DD3675 (NM)
- Practice address
- 114 W 11TH Street
Silver City, NM 88061-5136 - Phone
- (575) 388-1511
- NPI assigned
- Jun 19, 2012
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NM
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190222001347 | NM | Order and Referring Only - Dentist |
2860731627 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DD3675 | NM | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DD3675 | NM | Yes |
Addresses
Primary practice location
114 W 11TH Street
Silver City, NM 88061-5136
Mailing address
530 Demoss Street
Lordsburg, NM 88045-2618
Phone (575) 542-8384
Other providers in Silver City, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 19, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.