Provider Demographics
NPI:1003146135
Name:BELLAVANCE, DEBORAH L (DMD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:L
Last Name:BELLAVANCE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 BALDWIN GREEN CMN
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-1865
Mailing Address - Country:US
Mailing Address - Phone:781-932-5999
Mailing Address - Fax:
Practice Address - Street 1:3 BALDWIN GREEN CMN
Practice Address - Street 2:SUITE 101
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-1865
Practice Address - Country:US
Practice Address - Phone:781-932-5999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-12
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA21349122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist