MEDICARE: JOHN EDWARD BILODEAU DDS,MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry		VA

General Provider Information

NPI Number	:	1518932086
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN EDWARD BILODEAU DDS,MS

Provider Business Mailing Address
First Line	:	6116 ROLLING RD
Second Line	:	SUITE 201
City	:	SPRINGFIELD
State	:	VA
Zip	:	22152-1521
Country	:	US
Telephone Number	:	703-451-4666
Fax Number	:	703-866-0741

Provider Business Practice Location Address
First Line	:	6116 ROLLING RD
Second Line	:	SUITE 201
City	:	SPRINGFIELD
State	:	VA
Zip	:	22152-1521
Country	:	US
Telephone Number	:	703-451-4666
Fax Number	:	703-866-0741

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/20/2006
Last Update Date	:	07/08/2007

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