Provider Demographics
NPI:1023182029
Name:BELLEFONTE CHILDRENS DENTISTRY PC
Entity Type:Organization
Organization Name:BELLEFONTE CHILDRENS DENTISTRY PC
Other - Org Name:PEDIATRIC DENTISTRY OF NAPLES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT / PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:BARONIS
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:239-260-7672
Mailing Address - Street 1:1879 VETERANS PARK DR
Mailing Address - Street 2:SUITE1203
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-0500
Mailing Address - Country:US
Mailing Address - Phone:239-260-7672
Mailing Address - Fax:239-790-0927
Practice Address - Street 1:1879 VETERANS PARK DR
Practice Address - Street 2:SUITE1203
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-0500
Practice Address - Country:US
Practice Address - Phone:239-260-7672
Practice Address - Fax:239-790-0927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 209701223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2557853Medicaid
WV3810002455Medicaid
KY60003225Medicaid