Healthcare Provider Details

I. General information

NPI: 1225884059
Provider Name (Legal Business Name): DAVID R BEBERWYK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2024
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 INDEPENDENCE BLDG 1100
COLUMBUS MS
39710-5300
US

IV. Provider business mailing address

201 INDEPENDENCE BLDG 1100
COLUMBUS MS
39710-5300
US

V. Phone/Fax

Practice location:
  • Phone: 662-434-2273
  • Fax:
Mailing address:
  • Phone: 662-434-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDEN-DEN-LIC-28419
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: