Provider Demographics
NPI:1710354162
Name:MICHAEL J. BELTON DDS,MD INC.
Entity Type:Organization
Organization Name:MICHAEL J. BELTON DDS,MD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS,MD
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:BELTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS,MD
Authorized Official - Phone:951-537-2402
Mailing Address - Street 1:2045 COMPTON AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92881-7293
Mailing Address - Country:US
Mailing Address - Phone:951-537-2402
Mailing Address - Fax:
Practice Address - Street 1:2045 COMPTON AVE STE 102
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881-7293
Practice Address - Country:US
Practice Address - Phone:951-537-2402
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-01
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52203204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty