Provider Demographics
NPI:1972691681
Name:BELCHER, MARK ALAN (DDS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:ALAN
Last Name:BELCHER
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 1:125 W COLUMBIAN BLVD S
Mailing Address - Street 2:P.O. BOX 434
Mailing Address - City:LITCHFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62056-3021
Mailing Address - Country:US
Mailing Address - Phone:217-324-2610
Mailing Address - Fax:217-324-2637
Practice Address - Street 1:125 W COLUMBIAN BLVD S
Practice Address - Street 2:
Practice Address - City:LITCHFIELD
Practice Address - State:IL
Practice Address - Zip Code:62056-3021
Practice Address - Country:US
Practice Address - Phone:217-324-2610
Practice Address - Fax:217-324-2637
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice