Provider Demographics
NPI:1487064911
Name:BELECEN, EVE LIBBY (DDS)
Entity type:Individual
Prefix:DR
First Name:EVE
Middle Name:LIBBY
Last Name:BELECEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10225 67TH DR
Mailing Address - Street 2:APT 5R
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-2860
Mailing Address - Country:US
Mailing Address - Phone:516-729-1448
Mailing Address - Fax:
Practice Address - Street 1:10225 67TH DR
Practice Address - Street 2:APT 5R
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-2860
Practice Address - Country:US
Practice Address - Phone:516-729-1448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-06
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY057905-1122300000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04224719Medicaid