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General NPI Number Information
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NPI Number | 1467481002
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Entity Type | Organization
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Legal Business Name | ORTHODONTIC ASSOCIATES OF THE SOUTHERN TIER P.C.
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Dates
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Enumeration Date | 07/03/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 440 E WATER ST
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City | ELMIRA
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State | NY
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Zip | 14901-3411
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Country | US
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Telephone | 607-733-7163
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Fax | 607-737-6227
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Provider Business Mailing Address
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Address Line | 440 E WATER ST
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City | ELMIRA
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State | NY
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Zip | 14901-3411
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Country | US
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Telephone | 607-733-7163
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Fax | 607-737-6227
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RONALD M. BELLOHUSEN
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Credential | DMD
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Telephone | 607-733-7163
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 033848
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License Number State | NY
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