Provider Demographics
NPI:1598870784
Name:BELT LINE DENTAL PC
Entity Type:Organization
Organization Name:BELT LINE DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AN
Authorized Official - Middle Name:TAT
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-258-8354
Mailing Address - Street 1:2644 N BELT LINE RD
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062-5245
Mailing Address - Country:US
Mailing Address - Phone:972-258-8354
Mailing Address - Fax:972-570-2418
Practice Address - Street 1:2644 N BELT LINE RD
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-5245
Practice Address - Country:US
Practice Address - Phone:972-258-8354
Practice Address - Fax:972-570-2418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty