Provider Demographics
NPI:1649290487
Name:BELGUM, CYNTHIA
Entity type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:
Last Name:BELGUM
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:CYNTHIA
Other - Middle Name:
Other - Last Name:BELGUM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:1736 PICASSO AVE STE D
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-0548
Mailing Address - Country:US
Mailing Address - Phone:530-756-3340
Mailing Address - Fax:
Practice Address - Street 1:1736 PICASSO AVE STE D
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-0548
Practice Address - Country:US
Practice Address - Phone:530-756-3340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31022122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist