Provider Demographics
NPI:1790065019
Name:BEBAWI, REVENDA (DDS)
Entity Type:Individual
Prefix:DR
First Name:REVENDA
Middle Name:
Last Name:BEBAWI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIT 28038
Mailing Address - Street 2:USA DENTAC BAVARIA
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09112
Mailing Address - Country:US
Mailing Address - Phone:0114963719-464-3980
Mailing Address - Fax:
Practice Address - Street 1:UNIT 28038
Practice Address - Street 2:USA DENTAC BAVARIA
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09112
Practice Address - Country:US
Practice Address - Phone:0114963719-464-3980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-17
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014140561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice