Provider Demographics
NPI:1134616675
Name:PHAN, BELINDA HO (DMD)
Entity type:Individual
Prefix:DR
First Name:BELINDA
Middle Name:HO
Last Name:PHAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5520 CASTLEBERRY RD # 200
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-8054
Mailing Address - Country:US
Mailing Address - Phone:770-203-0100
Mailing Address - Fax:
Practice Address - Street 1:5520 CASTLEBERRY RD # 200
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-8054
Practice Address - Country:US
Practice Address - Phone:770-203-0100
Practice Address - Fax:770-203-0101
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-19
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN1222161223P0221X, 1223P0221X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program