Anthony Ray Belisle Jr., L.D.

Primary specialty

DenturistTaxonomy code 122400000X

License

DT-DO-1003340 Issued in OR

Practice address

965 S 1St St
Coos Bay, OR 97420-1401

Phone

(541) 267-7278

Fax

(541) 269-4613

NPI assigned

Sep 2, 2009

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1251849600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1251849600000",
    "number": "1740413012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3520",
            "city": "COOS BAY",
            "state": "OR",
            "postal_code": "974200418",
            "telephone_number": "541-267-7278",
            "fax_number": "541-269-4613"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "965 S 1ST ST",
            "city": "COOS BAY",
            "state": "OR",
            "postal_code": "974201401",
            "telephone_number": "541-267-7278",
            "fax_number": "541-269-4613"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BELISLE",
        "first_name": "ANTHONY",
        "middle_name": "RAY",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "L.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-09-02",
        "last_updated": "2009-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122400000X",
            "taxonomy_group": "",
            "desc": "Denturist",
            "state": "OR",
            "license": "DT-DO-1003340",
            "primary": true
        },
        {
            "code": "126900000X",
            "taxonomy_group": "",
            "desc": "Dental Laboratory Technician",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Denturist in Coos Bay, OR
• Providers in Coos Bay, OR by specialty
• Denturist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2009; 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.