Provider Demographics
NPI:1730388091
Name:JULIE LAVERDIERE BECK DDS, LTD.
Entity type:Organization
Organization Name:JULIE LAVERDIERE BECK DDS, LTD.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:LAVERDIERE BECK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-998-9992
Mailing Address - Street 1:2614 PATRIOT BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-8024
Mailing Address - Country:US
Mailing Address - Phone:847-998-9992
Mailing Address - Fax:847-998-9950
Practice Address - Street 1:2614 PATRIOT BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-8024
Practice Address - Country:US
Practice Address - Phone:847-998-9992
Practice Address - Fax:847-998-9950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-16
Last Update Date:2007-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery