Provider Demographics
NPI:1598801581
Name:BELOKONNY, DAVID (DDS)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:BELOKONNY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31350 TELEGRAPH RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-4366
Mailing Address - Country:US
Mailing Address - Phone:248-646-0064
Mailing Address - Fax:248-566-4097
Practice Address - Street 1:31350 TELEGRAPH RD
Practice Address - Street 2:SUITE 203
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-4366
Practice Address - Country:US
Practice Address - Phone:248-646-0064
Practice Address - Fax:248-566-4097
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010124521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice