Healthcare Provider Details

I. General information

NPI: 1285358309
Provider Name (Legal Business Name): BESLO DIABETES CONSULTING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2022
Last Update Date: 11/15/2022
Certification Date: 11/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 BRACKET POINT CT
DURHAM NC
27704-6138
US

IV. Provider business mailing address

PO BOX 11964
DURHAM NC
27703-1964
US

V. Phone/Fax

Practice location:
  • Phone: 984-206-4510
  • Fax: 919-999-8803
Mailing address:
  • Phone: 984-206-4510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code1835N1003X
TaxonomyNutrition Support Pharmacist
License Number
License Number State

VIII. Authorized Official

Name: DR. MARICO DOVE
Title or Position: OWNER
Credential: PHARMD
Phone: 984-206-4510