Healthcare Provider Details

I. General information

NPI: 1407850084
Provider Name (Legal Business Name): CHAD MICHAEL BELONGEA D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2005
Last Update Date: 03/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7735 W LONG DR UNIT 9
LITTLETON CO
80123-1262
US

IV. Provider business mailing address

10843 HEATHERTON ST
HIGHLANDS RANCH CO
80130-6622
US

V. Phone/Fax

Practice location:
  • Phone: 303-933-8880
  • Fax: 303-442-4396
Mailing address:
  • Phone: 419-779-0985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30021385
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDEN.00201939
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: