Provider Demographics
NPI:1346867678
Name:DEBEBE, ADDAM (DMD)
Entity Type:Individual
Prefix:DR
First Name:ADDAM
Middle Name:
Last Name:DEBEBE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5151 BENT TREE FOREST DR APT 207
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248-3664
Mailing Address - Country:US
Mailing Address - Phone:818-231-5195
Mailing Address - Fax:
Practice Address - Street 1:2180 FM 423 STE 200
Practice Address - Street 2:
Practice Address - City:LITTLE ELM
Practice Address - State:TX
Practice Address - Zip Code:75068-6695
Practice Address - Country:US
Practice Address - Phone:972-332-4127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-02
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX362461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice