MEDICARE: CHRISTINA BELOUSOV DDS, MBS

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	36532	TX

General Provider Information

NPI Number	:	1184236895
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINA BELOUSOV DDS, MBS

Provider Business Mailing Address
First Line	:	936 ROSEWOOD DR APT B
Second Line	:
City	:	HARKER HEIGHTS
State	:	TX
Zip	:	76548-2651
Country	:	US
Telephone Number	:	717-940-7151
Fax Number	:

Provider Business Practice Location Address
First Line	:	14351 BATTALION AVE
Second Line	:
City	:	APO
State	:	AA
Zip	:	76544
Country	:	US
Telephone Number	:	254-288-7848
Fax Number	:

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

Provider Enumeration Date	:	08/24/2020
Last Update Date	:	08/24/2020

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