NPIMap

Individual provider Active NPI

Deborah L Bellavance, DMD

  • Dentist
  • Woburn, MA
National Provider Identifier
1003146135
Registry record updated Jan 12, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
21349 Issued in MA
Practice address
3 Baldwin Green CMN
Suite 101
Woburn, MA 01801-1865
Phone
(781) 932-5999
NPI assigned
Jan 12, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 21349 MA Primary

Addresses

Primary practice location

3 Baldwin Green CMN
Suite 101
Woburn, MA 01801-1865

Mailing address

3 Baldwin Green CMN
Suite 101
Woburn, MA 01801-1865
Phone (781) 932-5999

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
21349MAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Lukasiewicz and Bellavance LLC PastSince Jul 24, 2022 Accepting new patients
Kevin P Mooney DDS PC Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1263254400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1263254400000",
    "number": "1003146135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 BALDWIN GREEN CMN",
            "address_2": "SUITE 101",
            "city": "WOBURN",
            "state": "MA",
            "postal_code": "018011865",
            "telephone_number": "781-932-5999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 BALDWIN GREEN CMN",
            "address_2": "SUITE 101",
            "city": "WOBURN",
            "state": "MA",
            "postal_code": "018011865",
            "telephone_number": "781-932-5999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BELLAVANCE",
        "first_name": "DEBORAH",
        "middle_name": "L",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-01-12",
        "last_updated": "2010-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MA",
            "license": "21349",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Woburn, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.