Healthcare Provider Details

I. General information

NPI: 1659596831
Provider Name (Legal Business Name): AHMED E BEBAWI D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5601 CORPORATE WAY STE .107
WEST PALM BEACH FL
33407-2025
US

IV. Provider business mailing address

5601 CORPORATE WAY STE .107
WEST PALM BEACH FL
33407-2025
US

V. Phone/Fax

Practice location:
  • Phone: 561-684-3303
  • Fax: 561-684-4634
Mailing address:
  • Phone: 561-684-3303
  • Fax: 561-684-4634

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN 8503
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: