Provider Demographics
NPI:1972706950
Name:BEEBE, BRYAN MARSHALL (DDS)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:MARSHALL
Last Name:BEEBE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2055 N 22ND AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718
Mailing Address - Country:US
Mailing Address - Phone:406-587-7668
Mailing Address - Fax:406-587-7670
Practice Address - Street 1:2055 N 22ND AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-2783
Practice Address - Country:US
Practice Address - Phone:406-587-7668
Practice Address - Fax:406-587-7670
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL133911223E0200X
MD77951223E0200X
MT59831223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics