Healthcare Provider Details

I. General information

NPI: 1326186206
Provider Name (Legal Business Name): DONALD E BELLEBAUM D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7455 CROSS COUNTY RD SUITE 5
N CHARLESTON SC
29418-8470
US

IV. Provider business mailing address

7455 CROSS COUNTY RD SUITE 5
N CHARLESTON SC
29418-8470
US

V. Phone/Fax

Practice location:
  • Phone: 843-552-4771
  • Fax:
Mailing address:
  • Phone: 843-552-4771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2903
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: