Healthcare Provider Details

I. General information

NPI: 1720174832
Provider Name (Legal Business Name): MICHAEL JOHN BELTON DDS, MD INC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 06/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10470 FOOTHILL BLVD SUITE 122
RANCHO CUCAMONGA CA
91730-3754
US

IV. Provider business mailing address

9471 JACK RABBIT DR UNIT 103
RANCHO CUCAMONGA CA
91730-2776
US

V. Phone/Fax

Practice location:
  • Phone: 909-989-2303
  • Fax:
Mailing address:
  • Phone: 909-483-6864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number52203
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberA90801
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: