MEDICARE: DR. JON MICHAEL BELLAMY DDS

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	6121	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366451882
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JON MICHAEL BELLAMY DDS

Provider Business Mailing Address
First Line	:	8025 CORPORATE CENTER DR
Second Line	:	SUITE 100
City	:	CHARLOTTE
State	:	NC
Zip	:	28226-4499
Country	:	US
Telephone Number	:	704-543-7800
Fax Number	:

Provider Business Practice Location Address
First Line	:	8025 CORPORATE CENTER DR
Second Line	:	SUITE 100
City	:	CHARLOTTE
State	:	NC
Zip	:	28226-4499
Country	:	US
Telephone Number	:	704-543-7800
Fax Number	:

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

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	02/17/2014

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