Phoenix Maxillofacial Trauma Associates, LLC

Primary specialty

Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X

License

47593 Issued in AZ

Legal business name

PHOENIX MAXILLOFACIAL TRAUMA ASSOCIATES, LLC

Practice address

5410 N Scottsdale Rd
Suite B-110
Paradise Valley, AZ 85253-5927

Phone

(480) 300-7152

Fax

(480) 725-0228

NPI assigned

Oct 23, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Nicolas Philippe Bebeau, MD, DDS

Title

Owner

Phone

(480) 300-7152

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1382486400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1382486400000",
    "number": "1114355575",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5410 N SCOTTSDALE RD",
            "address_2": "SUITE B-110",
            "city": "PARADISE VALLEY",
            "state": "AZ",
            "postal_code": "852535927",
            "telephone_number": "480-300-7152",
            "fax_number": "480-725-0228"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5410 N SCOTTSDALE RD",
            "address_2": "SUITE B-110",
            "city": "PARADISE VALLEY",
            "state": "AZ",
            "postal_code": "852535927",
            "telephone_number": "480-300-7152",
            "fax_number": "480-725-0228"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX MAXILLOFACIAL TRAUMA ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-23",
        "last_updated": "2013-10-23",
        "status": "A",
        "authorized_official_last_name": "BEBEAU",
        "authorized_official_first_name": "NICOLAS",
        "authorized_official_middle_name": "PHILIPPE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "480-300-7152",
        "authorized_official_credential": "MD, DDS"
    },
    "taxonomies": [
        {
            "code": "204E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "AZ",
            "license": "47593",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Oral & Maxillofacial Surgery (D.M.D.) in Paradise Valley, AZ
• Providers in Paradise Valley, AZ by specialty
• Oral & Maxillofacial Surgery (D.M.D.) in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.