Provider Demographics
NPI:1588802680
Name:BELTON COMPREHENSIVE DENTISTRY
Entity Type:Organization
Organization Name:BELTON COMPREHENSIVE DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:P.
Authorized Official - Middle Name:HAMPTON
Authorized Official - Last Name:KENNEMORE
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:864-338-6589
Mailing Address - Street 1:PO BOX 649
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:SC
Mailing Address - Zip Code:29627-0649
Mailing Address - Country:US
Mailing Address - Phone:864-338-6589
Mailing Address - Fax:864-338-0722
Practice Address - Street 1:1000 PINE TOP RD
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:SC
Practice Address - Zip Code:29627-9539
Practice Address - Country:US
Practice Address - Phone:864-338-6589
Practice Address - Fax:864-338-0722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-27
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC41081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty