Provider Demographics
NPI:1053487934
Name:BELBAS, JOHN PAUL (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:PAUL
Last Name:BELBAS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5995 BIG TREE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:LAKEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14480-9735
Mailing Address - Country:US
Mailing Address - Phone:585-346-5220
Mailing Address - Fax:585-346-5889
Practice Address - Street 1:5995 BIG TREE RD
Practice Address - Street 2:SUITE B
Practice Address - City:LAKEVILLE
Practice Address - State:NY
Practice Address - Zip Code:14480-9735
Practice Address - Country:US
Practice Address - Phone:585-346-5220
Practice Address - Fax:585-346-5889
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0402861223G0001X
AZ63811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01937548Medicaid