Individual
MR. ANTHONY RAY BELISLE JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
L.D.
Contact information
Practice address
965 S 1ST ST, COOS BAY, OR 97420-1401
(541) 267-7278
(541) 269-4613
Mailing address
PO BOX 3520, COOS BAY, OR 97420-0418
(541) 267-7278
(541) 269-4613
Taxonomy
Speciality
Code
Description
License number
State
122400000X
Denturist
Primary
DT-DO-1003340
OR
126900000X
Dental Laboratory Technician
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—
Other
Enumeration date
09/02/2009
Last updated
09/02/2009
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