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General NPI Number Information
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NPI Number | 1063862589
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Entity Type | Individual
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Provider Name | LAUREN ELISE BELOUS D.M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/15/2016
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Last Update Date | 03/06/2019
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Provider Practice Location Address
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Address Line | 1500 WALNUT ST STE 600
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City | PHILADELPHIA
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State | PA
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Zip | 19102-3504
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Country | US
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Telephone | 215-755-1001
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Fax |
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Provider Business Mailing Address
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Address Line | 1500 WALNUT ST STE 600
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City | PHILADELPHIA
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State | PA
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Zip | 19102-3504
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Country | US
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Telephone | 215-755-1001
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN1857250
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | DS041666
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License Number State | PA
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