Provider Demographics
NPI:1275987752
Name:BELMONT DENTISTRY PLC
Entity Type:Organization
Organization Name:BELMONT DENTISTRY PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:KLOOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:616-284-3200
Mailing Address - Street 1:1259 POST DR NE STE E
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:MI
Mailing Address - Zip Code:49306-8717
Mailing Address - Country:US
Mailing Address - Phone:616-284-3200
Mailing Address - Fax:
Practice Address - Street 1:1259 POST DR NE STE E
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:MI
Practice Address - Zip Code:49306-8717
Practice Address - Country:US
Practice Address - Phone:616-284-3200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-20
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901017901122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty