Provider Demographics
NPI:1730630625
Name:ELYSIA P. BELVA D.D.S., P.L.L.C.
Entity type:Organization
Organization Name:ELYSIA P. BELVA D.D.S., P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELYSIA
Authorized Official - Middle Name:PARHAM
Authorized Official - Last Name:BELVA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:423-580-2407
Mailing Address - Street 1:1724 HAMILL RD
Mailing Address - Street 2:SUITE 114
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-5152
Mailing Address - Country:US
Mailing Address - Phone:423-580-2407
Mailing Address - Fax:
Practice Address - Street 1:1724 HAMILL RD
Practice Address - Street 2:SUITE 114
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-5152
Practice Address - Country:US
Practice Address - Phone:423-580-2407
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-17
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9069261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1275869034OtherINDIVIDUAL NPI