Provider Demographics
NPI:1720174832
Name:BELTON, MICHAEL JOHN (DDS, MD INC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JOHN
Last Name:BELTON
Suffix:
Gender:M
Credentials:DDS, MD INC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9471 JACK RABBIT DR
Mailing Address - Street 2:UNIT 103
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-2776
Mailing Address - Country:US
Mailing Address - Phone:909-483-6864
Mailing Address - Fax:
Practice Address - Street 1:10470 FOOTHILL BLVD
Practice Address - Street 2:SUITE 122
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-3754
Practice Address - Country:US
Practice Address - Phone:909-989-2303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52203122300000X
CAA90801204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No122300000XDental ProvidersDentist