MEDICARE: DR. ANDRE JEAN BERUBE DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DN0011221	FL

General Provider Information

NPI Number	:	1265523633
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDRE JEAN BERUBE DMD

Provider Business Mailing Address
First Line	:	5240 BABCOCK ST NE
Second Line	:	SUITE 205
City	:	PALM BAY
State	:	FL
Zip	:	32905
Country	:	US
Telephone Number	:	321-722-2193
Fax Number	:	321-953-2888

Provider Business Practice Location Address
First Line	:	5240 BABCOCK ST NE
Second Line	:	SUITE 205
City	:	PALM BAY
State	:	FL
Zip	:	32905
Country	:	US
Telephone Number	:	321-722-2193
Fax Number	:	321-953-2888

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	07/08/2007

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