Provider Demographics
NPI:1871508259
Name:BIEBUYCK, JEAN-MARIE
Entity Type:Individual
Prefix:DR
First Name:JEAN-MARIE
Middle Name:
Last Name:BIEBUYCK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 W CANTON ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-1202
Mailing Address - Country:US
Mailing Address - Phone:978-985-5353
Mailing Address - Fax:
Practice Address - Street 1:412 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BRADFORD
Practice Address - State:MA
Practice Address - Zip Code:01835-7210
Practice Address - Country:US
Practice Address - Phone:978-985-5353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA171971223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health