Provider Demographics
NPI:1558832972
Name:BELTERRA KIDS TEETH
Entity Type:Organization
Organization Name:BELTERRA KIDS TEETH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:BABOT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:512-229-0604
Mailing Address - Street 1:165 HARGRAVES DR STE M100
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78737-4810
Mailing Address - Country:US
Mailing Address - Phone:512-229-0604
Mailing Address - Fax:
Practice Address - Street 1:165 HARGRAVES DR STE M100
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78737-4810
Practice Address - Country:US
Practice Address - Phone:512-229-0604
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-11
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty