Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | DN1857250 | MA |
Y | 1223E0200X | Endodontist | DS041666 | PA |
NPI | 1063862589 |
---|---|
Provider Name | Dr. Lauren Elise Belous |
First Address | Philadelphia, PA 19102-3504 |
Second Address | Philadelphia, PA 19102-3504 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2016 |
Last Update Date | 06/03/2019 |