Healthcare Provider Details

I. General information

NPI: 1164540977
Provider Name (Legal Business Name): ROBERT FESTUS BELFON DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 11/25/2020
Certification Date: 11/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1575 B STATE HWY 264
TSE BONITO NM
87301-3339
US

IV. Provider business mailing address

1575 B STATE HWY 264
TSE BONITO NM
87301-3339
US

V. Phone/Fax

Practice location:
  • Phone: 505-371-5509
  • Fax: 505-371-5513
Mailing address:
  • Phone: 505-371-5509
  • Fax: 505-371-5513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: