Provider Demographics
NPI:1700921822
Name:BELZ, JEFFREY D (DDS)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:D
Last Name:BELZ
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 1:642 UPTOWN BLVD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-3519
Mailing Address - Country:US
Mailing Address - Phone:469-272-8505
Mailing Address - Fax:469-272-8508
Practice Address - Street 1:642 UPTOWN BLVD
Practice Address - Street 2:SUITE 160
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-3519
Practice Address - Country:US
Practice Address - Phone:469-272-8505
Practice Address - Fax:469-272-8508
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX157711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice