Provider Demographics
NPI:1184918302
Name:AYMME S BELEN DMD PC
Entity type:Organization
Organization Name:AYMME S BELEN DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AYMME
Authorized Official - Middle Name:S
Authorized Official - Last Name:BELEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:315-724-3767
Mailing Address - Street 1:2628 GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-6003
Mailing Address - Country:US
Mailing Address - Phone:315-724-3768
Mailing Address - Fax:315-724-6345
Practice Address - Street 1:2628 GENESEE ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-6003
Practice Address - Country:US
Practice Address - Phone:315-724-3768
Practice Address - Fax:315-724-6345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-06
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY04925811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03327424Medicaid