Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 21349 | MA |
NPI | 1003146135 |
---|---|
Provider Name | Deborah L Bellavance |
First Address | Woburn, MA 01801-1865 |
Second Address | Woburn, MA 01801-1865 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2010 |
Last Update Date | 12/01/2010 |