Healthcare Provider Details

I. General information

NPI: 1154521888
Provider Name (Legal Business Name): NICOLE F BESU D.M.D., M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2007
Last Update Date: 07/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7735 NW 146TH ST STE 104
MIAMI LAKES FL
33016-1583
US

IV. Provider business mailing address

625 MAJORCA AVE
CORAL GABLES FL
33134-3752
US

V. Phone/Fax

Practice location:
  • Phone: 305-556-7010
  • Fax: 305-231-3984
Mailing address:
  • Phone: 305-321-8278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDN 16664
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: