| Organization Name: | PHOENIX MAXILLOFACIAL TRAUMA ASSOCIATES, LLC |
| NPI Number: | 1114355575 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | NICOLAS PHILIPPE BEBEAU (OWNER) |
| Mailing Address: | 5410 N Scottsdale Rd Suite B-110 Paradise Valley |
| State: | AZ US |
| Postal Code: | 852535927 |
| Phone Number: | 4803007152 |
| Fax Number: | 4807250228 |
| NPI Enumeration Date: | 10/23/2013 |
| NPI Last Update Date: | 10/23/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 204E00000X |
| License Number: | 47593 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AZ |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Oral & Maxillofacial Surgery |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |