MEDICARE: BELLE MEAD ORTHODONTIC CARE PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	10683NJ	NJ

General Provider Information

NPI Number	:	1063497154
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BELLE MEAD ORTHODONTIC CARE PA

Provider Business Mailing Address
First Line	:	2230 ROUTE 206
Second Line	:
City	:	BELLE MEAD
State	:	NJ
Zip	:	08502-4020
Country	:	US
Telephone Number	:	908-874-8360
Fax Number	:	908-874-5985

Provider Business Practice Location Address
First Line	:	2230 ROUTE 206
Second Line	:
City	:	BELLE MEAD
State	:	NJ
Zip	:	08502-4020
Country	:	US
Telephone Number	:	908-874-8360
Fax Number	:	908-874-5985

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

Provider Enumeration Date	:	12/12/2005
Last Update Date	:	11/25/2025

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