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General NPI Number Information
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NPI Number | 1730630625
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Entity Type | Organization
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Legal Business Name | ELYSIA P. BELVA D.D.S., P.L.L.C.
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Dates
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Enumeration Date | 10/17/2016
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Last Update Date | 10/17/2016
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Provider Practice Location Address
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Address Line | 1724 HAMILL RD SUITE 114
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City | HIXSON
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State | TN
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Zip | 37343-5152
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Country | US
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Telephone | 423-580-2407
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Fax |
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Provider Business Mailing Address
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Address Line | 1724 HAMILL RD SUITE 114
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City | HIXSON
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State | TN
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Zip | 37343-5152
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Country | US
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Telephone | 423-580-2407
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Fax |
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. ELYSIA PARHAM BELVA
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Credential | D.D.S.
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Telephone | 423-580-2407
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 9069
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License Number State | TN
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