MEDICARE: DR. LAUREN ELISE BELOUS D.M.D.

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	122300000X	Dentist	DN1857250	MA
2	1223E0200X	Endodontics	DS041666	PA

General Provider Information

NPI Number	:	1063862589
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAUREN ELISE BELOUS D.M.D.

Provider Business Mailing Address
First Line	:	1500 WALNUT ST STE 600
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19102-3504
Country	:	US
Telephone Number	:	215-755-1001
Fax Number	:

Provider Business Practice Location Address
First Line	:	1500 WALNUT ST STE 600
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19102-3504
Country	:	US
Telephone Number	:	215-755-1001
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2016
Last Update Date	:	03/06/2019

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