Provider Demographics
NPI:1710325311
Name:BELAVSKY, BENJAMIN ZALMAN (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:ZALMAN
Last Name:BELAVSKY
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9225 KARLOV AVE
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1732
Mailing Address - Country:US
Mailing Address - Phone:847-800-1815
Mailing Address - Fax:
Practice Address - Street 1:355 W DUNDEE RD STE 215
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089
Practice Address - Country:US
Practice Address - Phone:847-215-9971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-05
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019029399122300000X
IL0210027431223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist