Healthcare Provider Details

I. General information

NPI: 1750208179
Provider Name (Legal Business Name): BELFAST RIVER DENTAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11344 FORD AVE
RICHMOND HILL GA
31324-8882
US

IV. Provider business mailing address

11344 FORD AVE
RICHMOND HILL GA
31324-8882
US

V. Phone/Fax

Practice location:
  • Phone: 912-296-2023
  • Fax: 912-254-9272
Mailing address:
  • Phone: 912-296-2023
  • Fax: 912-254-9272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CASEY CASTLE
Title or Position: DIRECTOR OF PAYOR CONTRACTS
Credential:
Phone: 912-732-1504