Provider Demographics
NPI:1134228661
Name:BELGRADE, MOSES AARON (DDS)
Entity type:Individual
Prefix:DR
First Name:MOSES
Middle Name:AARON
Last Name:BELGRADE
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 1:416 N BEDFORD DR
Mailing Address - Street 2:STE.105
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4322
Mailing Address - Country:US
Mailing Address - Phone:310-276-2516
Mailing Address - Fax:310-276-2380
Practice Address - Street 1:416 N BEDFORD DR
Practice Address - Street 2:STE.105
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4322
Practice Address - Country:US
Practice Address - Phone:310-276-2516
Practice Address - Fax:310-276-2380
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA239141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA466654OtherUNITED CONCORDIA INS. CO.