Healthcare Provider Details

I. General information

NPI: 1124227475
Provider Name (Legal Business Name): NICOLAS P. BEBEAU DDS, MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2007
Last Update Date: 11/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5410 N SCOTTSDALE RD STE B-110
PARADISE VALLEY AZ
85253-5927
US

IV. Provider business mailing address

5410 N SCOTTSDALE RD STE B-110
PARADISE VALLEY AZ
85253-5927
US

V. Phone/Fax

Practice location:
  • Phone: 480-300-7152
  • Fax:
Mailing address:
  • Phone: 480-300-7152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number8403
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: