Provider Demographics
NPI:1942278833
Name:BELCHER, PERRY ALLEN (DDS)
Entity Type:Individual
Prefix:
First Name:PERRY
Middle Name:ALLEN
Last Name:BELCHER
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 1:119 NE FIRST ST
Mailing Address - Street 2:STE 4
Mailing Address - City:LITTLE FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:26345
Mailing Address - Country:US
Mailing Address - Phone:320-632-6621
Mailing Address - Fax:320-632-1829
Practice Address - Street 1:119 NE FIRST ST
Practice Address - Street 2:STE 4
Practice Address - City:LITTLE FALLS
Practice Address - State:MN
Practice Address - Zip Code:26345
Practice Address - Country:US
Practice Address - Phone:320-632-6621
Practice Address - Fax:320-632-1829
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND9820122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1265OtherHEALTH PARTNERS
85320FAOtherBLUE CROSS BLUE SHIELD
812989OtherUNITED OF CONCORDIA
U49609Medicare UPIN
19000069Medicare ID - Type Unspecified