Healthcare Provider Details

I. General information

NPI: 1437427929
Provider Name (Legal Business Name): PEDIATRIC AND SPECIAL CARE DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2011
Last Update Date: 12/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6800 MONTGOMERY BLVD NE SUITE F
ALBUQUERQUE NM
87109-1405
US

IV. Provider business mailing address

6800 MONTGOMERY BLVD NE SUITE F
ALBUQUERQUE NM
87109-1405
US

V. Phone/Fax

Practice location:
  • Phone: 505-883-7262
  • Fax: 505-883-4563
Mailing address:
  • Phone: 505-883-7262
  • Fax: 505-883-4563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number1860
License Number StateNM

VIII. Authorized Official

Name: DR. ROBERT F BELFON
Title or Position: PEDIATRIC DENTIST
Credential: DMD
Phone: 505-883-7262