Provider Demographics
NPI:1306860408
Name:BELKIN, EDWARD A (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:A
Last Name:BELKIN
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 1:1194 W. OLD HENDERSON ROAD
Mailing Address - Street 2:SUITE B
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-3694
Mailing Address - Country:US
Mailing Address - Phone:614-442-1810
Mailing Address - Fax:614-442-1812
Practice Address - Street 1:1194 W. OLD HENDERSON ROAD
Practice Address - Street 2:SUITE B
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-3694
Practice Address - Country:US
Practice Address - Phone:614-442-1810
Practice Address - Fax:614-442-1812
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30017473122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist