Provider Demographics
NPI:1144577628
Name:BECKER, AUTUMN LEIGH-ANN (DMD)
Entity type:Individual
Prefix:DR
First Name:AUTUMN
Middle Name:LEIGH-ANN
Last Name:BECKER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:AUTUMN
Other - Middle Name:LEIGH-ANN
Other - Last Name:EDWARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:1310 STONEWALL RDG
Mailing Address - Street 2:
Mailing Address - City:HARKER HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:76548-1694
Mailing Address - Country:US
Mailing Address - Phone:502-693-4306
Mailing Address - Fax:
Practice Address - Street 1:USA DENTAC FORT CAVAZOS
Practice Address - Street 2:36000 SHOEMAKER LANE, SUITE 1051
Practice Address - City:FORT CAVAZOS
Practice Address - State:TX
Practice Address - Zip Code:76544
Practice Address - Country:US
Practice Address - Phone:254-287-2705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-14
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS608711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice