Provider Demographics
NPI:1528416732
Name:BELOUS, BRADLEY TYLER (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:TYLER
Last Name:BELOUS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 E MARSHALL ST STE 106
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-4443
Mailing Address - Country:US
Mailing Address - Phone:484-999-0956
Mailing Address - Fax:
Practice Address - Street 1:600 E MARSHALL ST STE 106
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-4443
Practice Address - Country:US
Practice Address - Phone:484-999-0956
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-27
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0408321223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery