MEDICARE: BEAR-APPALOOSA LLC

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	122300000X	Dentist

General Provider Information

NPI Number	:	1679398572
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEAR-APPALOOSA LLC

Provider Business Mailing Address
First Line	:	1229 QUINTILIO DR
Second Line	:
City	:	BEAR
State	:	DE
Zip	:	19701-6005
Country	:	US
Telephone Number	:	302-838-8600
Fax Number	:

Provider Business Practice Location Address
First Line	:	1229 QUINTILIO DR
Second Line	:
City	:	BEAR
State	:	DE
Zip	:	19701-6005
Country	:	US
Telephone Number	:	302-838-8600
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	NICHOLAS DEBARI
Credential	:
Telephone Number	:	929-618-7162

Provider Enumeration Date	:	11/18/2024
Last Update Date	:	05/19/2026

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Directions to “BEAR-APPALOOSA LLC ” Practice Location

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