Healthcare Provider Details

I. General information

NPI: 1841405479
Provider Name (Legal Business Name): WILLIAM R BEBRIN D.M.D., D.M.SC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 S MAIN ST
MIDDLETON MA
01949-3303
US

IV. Provider business mailing address

119 S MAIN ST
MIDDLETON MA
01949-3303
US

V. Phone/Fax

Practice location:
  • Phone: 978-777-1300
  • Fax:
Mailing address:
  • Phone: 978-777-1300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number17481
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: