Healthcare Provider Details

I. General information

NPI: 1376642710
Provider Name (Legal Business Name): HARRY CLINTON BELK JR. DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 POWELL MILL ROAD
SPARTANBURG SC
29301
US

IV. Provider business mailing address

115 POWELL MILL ROAD
SPARTANBURG SC
29301
US

V. Phone/Fax

Practice location:
  • Phone: 864-574-2011
  • Fax: 864-576-7377
Mailing address:
  • Phone: 864-574-2011
  • Fax: 864-576-7377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number1723
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: