Provider Demographics
NPI:1598403974
Name:BELGIUM FAMILY DENTAL CENTER SC
Entity Type:Organization
Organization Name:BELGIUM FAMILY DENTAL CENTER SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:VALI
Authorized Official - Middle Name:
Authorized Official - Last Name:KIAIE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:262-285-3408
Mailing Address - Street 1:171 MAIN ST STE 200
Mailing Address - Street 2:
Mailing Address - City:BELGIUM
Mailing Address - State:WI
Mailing Address - Zip Code:53004-9715
Mailing Address - Country:US
Mailing Address - Phone:262-285-3408
Mailing Address - Fax:262-285-4025
Practice Address - Street 1:171 MAIN ST STE 200
Practice Address - Street 2:
Practice Address - City:BELGIUM
Practice Address - State:WI
Practice Address - Zip Code:53004-9715
Practice Address - Country:US
Practice Address - Phone:262-285-3408
Practice Address - Fax:262-285-4025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-25
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental