Provider Demographics
NPI:1255505319
Name:DR TOM BELFORD JR P C
Entity Type:Organization
Organization Name:DR TOM BELFORD JR P C
Other - Org Name:TOM D BELFORD JR DDS PC
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETHANY
Authorized Official - Middle Name:R
Authorized Official - Last Name:THIERBACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-785-7500
Mailing Address - Street 1:G2432 W CARPENTER RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48505-1983
Mailing Address - Country:US
Mailing Address - Phone:810-785-7500
Mailing Address - Fax:
Practice Address - Street 1:G2432 W CARPENTER RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48505-1983
Practice Address - Country:US
Practice Address - Phone:810-785-7500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-18
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI110081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4043454Medicaid
MI4864411Medicaid