Provider Demographics
NPI:1134485691
Name:BELMONT FAMILY DENTISTRY
Entity Type:Organization
Organization Name:BELMONT FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/TREATING DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:D
Authorized Official - Last Name:TINKLE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-234-1218
Mailing Address - Street 1:5935 SE BELMONT ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215-1925
Mailing Address - Country:US
Mailing Address - Phone:503-234-1218
Mailing Address - Fax:503-238-0981
Practice Address - Street 1:5935 SE BELMONT ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97215-1925
Practice Address - Country:US
Practice Address - Phone:503-234-1218
Practice Address - Fax:503-238-0981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-09
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD87661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty