Provider Demographics
NPI:1356427686
Name:BELTLINE SMILE CENTER PA
Entity type:Organization
Organization Name:BELTLINE SMILE CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:ARASH
Authorized Official - Last Name:BEIZALL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-466-0077
Mailing Address - Street 1:1614 E BELTLINE RD
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006
Mailing Address - Country:US
Mailing Address - Phone:972-466-0077
Mailing Address - Fax:972-466-1887
Practice Address - Street 1:1614 E BELTLINE RD
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006
Practice Address - Country:US
Practice Address - Phone:972-466-0077
Practice Address - Fax:972-466-1887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18072122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty