Healthcare Provider Details

I. General information

NPI: 1417300385
Provider Name (Legal Business Name): BEAU-CABEL ALEXANDRE BENT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2016
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 LAKES ST
NESPELEM WA
99155
US

IV. Provider business mailing address

PO BOX 150
NESPELEM WA
99155-0150
US

V. Phone/Fax

Practice location:
  • Phone: 509-634-2900
  • Fax: 509-634-2963
Mailing address:
  • Phone: 509-422-7416
  • Fax: 509-422-7712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE60661092
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: