Provider Demographics
NPI:1184236895
Name:BELOUSOV, CHRISTINA (DDS, MBS)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:BELOUSOV
Suffix:
Gender:F
Credentials:DDS, MBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:936 ROSEWOOD DR APT B
Mailing Address - Street 2:
Mailing Address - City:HARKER HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:76548-2651
Mailing Address - Country:US
Mailing Address - Phone:717-940-7151
Mailing Address - Fax:
Practice Address - Street 1:14351 BATTALION AVE
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AA
Practice Address - Zip Code:76544
Practice Address - Country:US
Practice Address - Phone:254-288-7848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX365321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice