Provider Demographics
NPI:1184823056
Name:BELNAP, DALE CLINTON (DDS)
Entity Type:Individual
Prefix:DR
First Name:DALE
Middle Name:CLINTON
Last Name:BELNAP
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 BROWN TRL
Mailing Address - Street 2:SUITE 101
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-3999
Mailing Address - Country:US
Mailing Address - Phone:817-528-4600
Mailing Address - Fax:
Practice Address - Street 1:4201 BROWN TRL
Practice Address - Street 2:SUITE 101
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-3999
Practice Address - Country:US
Practice Address - Phone:817-528-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0023456122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist