Provider Demographics
NPI:1316712755
Name:GARCIA BELISARIO, EUGENIA CAROLINA
Entity type:Individual
Prefix:
First Name:EUGENIA
Middle Name:CAROLINA
Last Name:GARCIA BELISARIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 LOCUST ST APT 105
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-5781
Mailing Address - Country:US
Mailing Address - Phone:781-666-1433
Mailing Address - Fax:
Practice Address - Street 1:20 LOCUST ST APT 105
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-5781
Practice Address - Country:US
Practice Address - Phone:781-666-1433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-15
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADA15176126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant