Provider Demographics
NPI:1063862589
Name:BELOUS, LAUREN ELISE (DMD)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:ELISE
Last Name:BELOUS
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 1:1500 WALNUT ST STE 600
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-3504
Mailing Address - Country:US
Mailing Address - Phone:215-755-1001
Mailing Address - Fax:
Practice Address - Street 1:1500 WALNUT ST STE 600
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-3504
Practice Address - Country:US
Practice Address - Phone:215-755-1001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-15
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1857250122300000X
PADS0416661223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist