Provider Demographics
NPI:1376642710
Name:BELK, HARRY CLINTON JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:HARRY
Middle Name:CLINTON
Last Name:BELK
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:115 POWELL MILL ROAD
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29301
Mailing Address - Country:US
Mailing Address - Phone:864-574-2011
Mailing Address - Fax:864-576-7377
Practice Address - Street 1:115 POWELL MILL ROAD
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29301
Practice Address - Country:US
Practice Address - Phone:864-574-2011
Practice Address - Fax:864-576-7377
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC1723204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890651EMedicaid
SCZA9924Medicaid
SCZA9924Medicaid