1972168839 NPI number — THE KIDS DENTAL PRACTICE

Table of content: DR. MARY FERGUSON BELMONT ED.D, N.P. (NPI 1265520878)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972168839 NPI number — THE KIDS DENTAL PRACTICE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE KIDS DENTAL PRACTICE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972168839
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/13/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15065 STATE ROAD 7
Provider Second Line Business Mailing Address:
STE 650
Provider Business Mailing Address City Name:
DELRAY BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33446
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15065 S STATE ROAD 7 STE 650
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DELRAY BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33446-4110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-840-5437
Provider Business Practice Location Address Fax Number:
561-840-1042
Provider Enumeration Date:
05/07/2019

Additional Information

Authorized Official

Authorized Official Last Name:
CAPRA
Authorized Official First Name:
SHANA
Authorized Official Middle Name:
Authorized Official Title or Position:
DENTIST/OWNER
Authorized Official Telephone Number:
954-534-6260

Provider Taxonomy Codes

  • Taxonomy code: 1223P0221X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 013292400 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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