Provider Demographics
NPI:1154521888
Name:BESU, NICOLE F (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:F
Last Name:BESU
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 MAJORCA AVE
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-3752
Mailing Address - Country:US
Mailing Address - Phone:305-321-8278
Mailing Address - Fax:
Practice Address - Street 1:7735 NW 146TH ST STE 104
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016-1583
Practice Address - Country:US
Practice Address - Phone:305-556-7010
Practice Address - Fax:305-231-3984
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-20
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 166641223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics