Healthcare Provider Details

I. General information

NPI: 1407968878
Provider Name (Legal Business Name): BELMONT DENTAL ASSOC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3210 E MARKET ST
YORK PA
17402
US

IV. Provider business mailing address

3210 E MARKET ST
YORK PA
17402
US

V. Phone/Fax

Practice location:
  • Phone: 717-848-1463
  • Fax: 717-848-6861
Mailing address:
  • Phone: 717-848-1463
  • Fax: 717-848-6861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS031255L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS025742L
License Number StatePA

VIII. Authorized Official

Name: ROBERT W BURY
Title or Position: OWNER
Credential: DDS
Phone: 717-848-1463