Provider Demographics
NPI:1194852350
Name:BELNAP, TIMOTHY M (DDS)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:M
Last Name:BELNAP
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13161 BLACK MOUNTAIN RD STE 5
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-2685
Mailing Address - Country:US
Mailing Address - Phone:858-484-9202
Mailing Address - Fax:858-484-9630
Practice Address - Street 1:13161 BLACK MOUNTAIN RD STE 5
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92129-2685
Practice Address - Country:US
Practice Address - Phone:858-484-9202
Practice Address - Fax:858-484-9630
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35222122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist