Provider Demographics
NPI:1790159853
Name:MICHELE A. BIBEAU, D.D.S.
Entity Type:Organization
Organization Name:MICHELE A. BIBEAU, D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BIBEAU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:928-776-0606
Mailing Address - Street 1:1058 FAIR STREET
Mailing Address - Street 2:SUITE A
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305
Mailing Address - Country:US
Mailing Address - Phone:928-776-0606
Mailing Address - Fax:928-776-0102
Practice Address - Street 1:1058 FAIR STREET
Practice Address - Street 2:SUITE A
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305
Practice Address - Country:US
Practice Address - Phone:928-776-0606
Practice Address - Fax:928-776-0102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-30
Last Update Date:2015-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty