Provider Demographics
NPI:1063490050
Name:BELEN, ERNESTO JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:ERNESTO
Middle Name:
Last Name:BELEN
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9314 E CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-2555
Mailing Address - Country:US
Mailing Address - Phone:316-686-6565
Mailing Address - Fax:316-866-2563
Practice Address - Street 1:9314 E CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-2555
Practice Address - Country:US
Practice Address - Phone:316-686-6565
Practice Address - Fax:316-866-2563
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS67711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice