MEDICARE: DR. JULIEN NADEAU BELLAVANCE DDS

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	122300000X	Dentist	0401414377	VA

General Provider Information

NPI Number	:	1821437203
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JULIEN NADEAU BELLAVANCE DDS

Provider Business Mailing Address
First Line	:	57 HEMLOCK PL
Second Line	:
City	:	ZION CROSSROADS
State	:	VA
Zip	:	22942-6987
Country	:	US
Telephone Number	:	405-808-0923
Fax Number	:

Provider Business Practice Location Address
First Line	:	34 JEFFERSON CT
Second Line	:
City	:	ZION CROSSROADS
State	:	VA
Zip	:	22942-9602
Country	:	US
Telephone Number	:	540-832-3232
Fax Number	:

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

Provider Enumeration Date	:	06/19/2013
Last Update Date	:	06/24/2014

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