Healthcare Provider Details

I. General information

NPI: 1164571808
Provider Name (Legal Business Name): VICTOR JEROME BELIVEAU DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9535 N CITRUS SPRINGS BLVD
CITRUS SPRINGS FL
34434
US

IV. Provider business mailing address

9535 N CITRUS SPRINGS BLVD
CITRUS SPRINGS FL
34434
US

V. Phone/Fax

Practice location:
  • Phone: 352-465-3008
  • Fax: 352-465-3009
Mailing address:
  • Phone: 352-465-3008
  • Fax: 352-465-3009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN14034
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: