Provider Demographics
NPI:1083239404
Name:BELDER, PHILLIP TAYLOR (DMD)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:TAYLOR
Last Name:BELDER
Suffix:
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 1:1414 DOGWOOD LN
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-2604
Mailing Address - Country:US
Mailing Address - Phone:215-264-3345
Mailing Address - Fax:
Practice Address - Street 1:528 STREET RD
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966-3747
Practice Address - Country:US
Practice Address - Phone:215-322-2262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-11
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0427141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice