Healthcare Provider Details

I. General information

NPI: 1891613154
Provider Name (Legal Business Name): SAMANTHA BELENSON DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4957 SWINYAR DR STE 107
COLLEGE DALE TN
37363-2205
US

IV. Provider business mailing address

49 FIRECREEK DR
RINGGOLD GA
30736-6687
US

V. Phone/Fax

Practice location:
  • Phone: 423-396-3154
  • Fax:
Mailing address:
  • Phone: 925-918-0230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number13210
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: