Healthcare Provider Details

I. General information

NPI: 1962432922
Provider Name (Legal Business Name): STEPHEN J. BELLORINI D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 04/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 BAYSTATE CT
BREWSTER MA
02631
US

IV. Provider business mailing address

11 BAYSTATE CT
BREWSTER MA
02631
US

V. Phone/Fax

Practice location:
  • Phone: 508-255-0111
  • Fax: 508-255-1160
Mailing address:
  • Phone: 508-255-0111
  • Fax: 508-255-1160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number22060
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: