MEDICARE: LIZANDRE BELANGER DMD

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	1223G0001X	General Practice Dentistry	16411	TX

General Provider Information

NPI Number	:	1073036901
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LIZANDRE BELANGER DMD

Provider Business Mailing Address
First Line	:	302 E JOSEPHINE ST STE 3101
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78215-1193
Country	:	US
Telephone Number	:	830-320-6583
Fax Number	:

Provider Business Practice Location Address
First Line	:	2133 PEPPERRELL ST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78236-5313
Country	:	US
Telephone Number	:	210-292-0123
Fax Number	:

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

Provider Enumeration Date	:	07/23/2017
Last Update Date	:	07/23/2017

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