Healthcare Provider Details

I. General information

NPI: 1063497154
Provider Name (Legal Business Name): BELLE MEAD ORTHODONTIC CARE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2005
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2230 ROUTE 206
BELLE MEAD NJ
08502-4020
US

IV. Provider business mailing address

2230 ROUTE 206
BELLE MEAD NJ
08502-4020
US

V. Phone/Fax

Practice location:
  • Phone: 908-874-8360
  • Fax: 908-874-5985
Mailing address:
  • Phone: 908-874-8360
  • Fax: 908-874-5985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number10683NJ
License Number StateNJ

VIII. Authorized Official

Name: DR. RICHARD D'AVANZO
Title or Position: OWNER/DENTIST
Credential: DDS
Phone: 609-709-0107