Provider Demographics
NPI:1144342692
Name:BECCACIO, ERNEST GEORGE (DDS)
Entity type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:GEORGE
Last Name:BECCACIO
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 1:915 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-4003
Mailing Address - Country:US
Mailing Address - Phone:831-422-6381
Mailing Address - Fax:831-424-8048
Practice Address - Street 1:100 COLONY RD
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93409-1000
Practice Address - Country:US
Practice Address - Phone:805-547-7807
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB0194121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice