Provider Demographics
NPI:1215073499
Name:BELMONT DENTAL GROUP
Entity type:Organization
Organization Name:BELMONT DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER, D.M.D.
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:L
Authorized Official - Last Name:NAGER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-484-2431
Mailing Address - Street 1:57 CONCORD AVE
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:MA
Mailing Address - Zip Code:02478-4073
Mailing Address - Country:US
Mailing Address - Phone:617-484-2431
Mailing Address - Fax:617-484-2745
Practice Address - Street 1:57 CONCORD AVE
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:MA
Practice Address - Zip Code:02478-4073
Practice Address - Country:US
Practice Address - Phone:617-484-2431
Practice Address - Fax:617-484-2745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAX10227OtherBLUE CROSS BLUE SHIELD