Provider Demographics
NPI:1790052801
Name:BELMONT FAMILY DENTAL CARE, LLC
Entity Type:Organization
Organization Name:BELMONT FAMILY DENTAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TRANG
Authorized Official - Middle Name:KIM
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:937-256-7277
Mailing Address - Street 1:1585 S SMITHVILLE RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45410-3242
Mailing Address - Country:US
Mailing Address - Phone:937-256-7277
Mailing Address - Fax:937-256-7250
Practice Address - Street 1:1585 S SMITHVILLE RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45410-3242
Practice Address - Country:US
Practice Address - Phone:937-256-7277
Practice Address - Fax:937-256-7250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-18
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH208081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty