Healthcare Provider Details

I. General information

NPI: 1114022613
Provider Name (Legal Business Name): BPLARRABEE INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 09/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1810 S CRISMON RD SUITE 183
MESA AZ
85209-3717
US

IV. Provider business mailing address

1810 S CRISMON RD SUITE 183
MESA AZ
85209-3717
US

V. Phone/Fax

Practice location:
  • Phone: 480-357-4900
  • Fax: 480-357-4904
Mailing address:
  • Phone: 480-357-4900
  • Fax: 480-357-4904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberD6671
License Number StateAZ

VIII. Authorized Official

Name: DR. BENJAMIN PATRICK LARRABEE
Title or Position: OWNER DOCTOR
Credential: D.D.S, M.S.
Phone: 480-357-4900