Provider Demographics
NPI:1710237722
Name:BELBASE, RICHA
Entity Type:Individual
Prefix:
First Name:RICHA
Middle Name:
Last Name:BELBASE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4186 GEORGETOWN RD
Mailing Address - Street 2:
Mailing Address - City:BLUE ASH
Mailing Address - State:OH
Mailing Address - Zip Code:45236-1054
Mailing Address - Country:US
Mailing Address - Phone:312-286-6459
Mailing Address - Fax:
Practice Address - Street 1:4186 GEORGETOWN RD
Practice Address - Street 2:
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45236-1054
Practice Address - Country:US
Practice Address - Phone:312-286-6459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-17
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0238281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice