Provider Demographics
NPI:1407567225
Name:BRYNDON JAMES BELNAP DDS MS PC
Entity Type:Organization
Organization Name:BRYNDON JAMES BELNAP DDS MS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYNDON
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:BELNAP
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:208-240-0202
Mailing Address - Street 1:1133 CALL CREEK DRIVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201
Mailing Address - Country:US
Mailing Address - Phone:208-232-0464
Mailing Address - Fax:
Practice Address - Street 1:1133 CALL CREEK DRIVE
Practice Address - Street 2:SUITE B
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201
Practice Address - Country:US
Practice Address - Phone:208-232-0464
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-13
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty