Provider Demographics
NPI:1285192740
Name:ADEBIMPE BEBE IBITAYO DDS MS PLLC
Entity Type:Organization
Organization Name:ADEBIMPE BEBE IBITAYO DDS MS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADEBIMPE
Authorized Official - Middle Name:
Authorized Official - Last Name:IBITAYO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:210-658-2251
Mailing Address - Street 1:106 ROSE GDN
Mailing Address - Street 2:
Mailing Address - City:UNIVERSAL CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78148-3422
Mailing Address - Country:US
Mailing Address - Phone:210-658-2251
Mailing Address - Fax:
Practice Address - Street 1:106 ROSE GDN
Practice Address - Street 2:
Practice Address - City:UNIVERSAL CITY
Practice Address - State:TX
Practice Address - Zip Code:78148-3422
Practice Address - Country:US
Practice Address - Phone:210-658-2251
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FI8127006OtherDEA