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General NPI Number Information
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NPI Number | 1164540977
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Entity Type | Individual
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Provider Name | ROBERT FESTUS BELFON DMD
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Gender | Male
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Dates
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Enumeration Date | 03/27/2007
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Last Update Date | 11/25/2020
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Provider Practice Location Address
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Address Line | 1575 B STATE HWY 264
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City | TSE BONITO
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State | NM
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Zip | 87301-3339
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Country | US
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Telephone | 505-371-5509
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Fax | 505-371-5513
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Provider Business Mailing Address
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Address Line | 1575 B STATE HWY 264
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City | TSE BONITO
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State | NM
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Zip | 87301-3339
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Country | US
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Telephone | 505-371-5509
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Fax | 505-371-5513
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 1860
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License Number State | NM
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