Provider Demographics
NPI:1275869034
Name:BELVA, ELYSIA P (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELYSIA
Middle Name:P
Last Name:BELVA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5213 HIXSON PIKE
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-3928
Mailing Address - Country:US
Mailing Address - Phone:423-877-9961
Mailing Address - Fax:423-877-8624
Practice Address - Street 1:5213 HIXSON PIKE
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-3928
Practice Address - Country:US
Practice Address - Phone:423-877-9961
Practice Address - Fax:423-877-8624
Is Sole Proprietor?:No
Enumeration Date:2009-10-28
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN90691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice