Provider Demographics
NPI:1114022613
Name:BPLARRABEE INCORPORATED
Entity Type:Organization
Organization Name:BPLARRABEE INCORPORATED
Other - Org Name:ADVANCED ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:LARRABEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:480-357-4900
Mailing Address - Street 1:1810 S CRISMON RD
Mailing Address - Street 2:SUITE 183
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85209-3717
Mailing Address - Country:US
Mailing Address - Phone:480-357-4900
Mailing Address - Fax:480-357-4904
Practice Address - Street 1:1810 S CRISMON RD
Practice Address - Street 2:SUITE 183
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209-3717
Practice Address - Country:US
Practice Address - Phone:480-357-4900
Practice Address - Fax:480-357-4904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD66711223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty