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General NPI Number Information
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NPI Number | 1912796822
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Entity Type | Organization
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Legal Business Name | BELMONT FAMILY DENTAL CARE PLLC
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Dates
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Enumeration Date | 05/06/2025
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Last Update Date | 05/06/2025
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Provider Practice Location Address
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Address Line | 385 CONCORD AVE STE 1
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City | BELMONT
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State | MA
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Zip | 02478-3037
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Country | US
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Telephone | 617-484-1920
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Fax |
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Provider Business Mailing Address
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Address Line | 385 CONCORD AVE STE 1
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City | BELMONT
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State | MA
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Zip | 02478-3037
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Country | US
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Telephone | 617-484-1920
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. ANDRE ANATOLY ZELIKOV
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Credential | DMD
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Telephone | 248-558-9476
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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