Healthcare Provider Details

I. General information

NPI: 1225108582
Provider Name (Legal Business Name): JOHN STEEN BELLERJEAU III D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1754 GOVERNMENT ST
MOBILE AL
36604-1111
US

IV. Provider business mailing address

2058 POINT LEGERE RD
MOBILE AL
36605-2812
US

V. Phone/Fax

Practice location:
  • Phone: 251-471-1516
  • Fax:
Mailing address:
  • Phone: 251-471-1516
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number4283
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: