Healthcare Provider Details

I. General information

NPI: 1407567225
Provider Name (Legal Business Name): BRYNDON JAMES BELNAP DDS MS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2022
Last Update Date: 12/13/2022
Certification Date: 12/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1133 CALL CREEK DRIVE SUITE B
POCATELLO ID
83201
US

IV. Provider business mailing address

1133 CALL CREEK DRIVE SUITE B
POCATELLO ID
83201
US

V. Phone/Fax

Practice location:
  • Phone: 208-232-0464
  • Fax:
Mailing address:
  • Phone: 208-232-0464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. BRYNDON JAMES BELNAP
Title or Position: OWNER
Credential: DDS
Phone: 208-240-0202