Provider Demographics
NPI:1801904933
Name:BELKNAP, MARVIN E (DDS)
Entity type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:E
Last Name:BELKNAP
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 1:617 WEST THOMAS
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:IA
Mailing Address - Zip Code:51601
Mailing Address - Country:US
Mailing Address - Phone:712-246-5587
Mailing Address - Fax:712-246-5586
Practice Address - Street 1:617 WEST THOMAS
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:IA
Practice Address - Zip Code:51601
Practice Address - Country:US
Practice Address - Phone:712-246-5587
Practice Address - Fax:712-246-5586
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA6012122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist