Healthcare Provider Details

I. General information

NPI: 1497619977
Provider Name (Legal Business Name): LAWRENCE CHARLES BELLON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 HIGHWAY K
BONNE TERRE MO
63628-3430
US

IV. Provider business mailing address

46 MEADOWBROOK
BALLWIN MO
63011-1694
US

V. Phone/Fax

Practice location:
  • Phone: 573-358-5516
  • Fax:
Mailing address:
  • Phone: 314-409-5219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number010416
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: