Healthcare Provider Details

I. General information

NPI: 1376243360
Provider Name (Legal Business Name): ROBERT GUSTAVUS BEEBE III DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2023
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 CHILD ST BLDG 964
JACKSONVILLE FL
32214-5005
US

IV. Provider business mailing address

2080 CHILD ST BLDG 964
JACKSONVILLE FL
32214-5005
US

V. Phone/Fax

Practice location:
  • Phone: 904-546-7100
  • Fax:
Mailing address:
  • Phone: 904-546-7100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number11530
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: