Provider Demographics
NPI:1902535974
Name:BECKER, LORI K (RDH)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:K
Last Name:BECKER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200960 DUBAY DR
Mailing Address - Street 2:
Mailing Address - City:MOSINEE
Mailing Address - State:WI
Mailing Address - Zip Code:54455-7504
Mailing Address - Country:US
Mailing Address - Phone:715-355-7920
Mailing Address - Fax:
Practice Address - Street 1:4060 S LAKE DR APT 4
Practice Address - Street 2:
Practice Address - City:ST FRANCIS
Practice Address - State:WI
Practice Address - Zip Code:53235-5256
Practice Address - Country:US
Practice Address - Phone:407-375-3003
Practice Address - Fax:800-863-5373
Is Sole Proprietor?:No
Enumeration Date:2022-06-06
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6733-016124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist