Provider Demographics
NPI:1144415449
Name:BELLAM, MAMATHA (DDS)
Entity Type:Individual
Prefix:
First Name:MAMATHA
Middle Name:
Last Name:BELLAM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6990 VILLAGE PKWY
Mailing Address - Street 2:STE 210
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-2438
Mailing Address - Country:US
Mailing Address - Phone:925-556-9074
Mailing Address - Fax:925-397-4700
Practice Address - Street 1:6990 VILLAGE PKWY
Practice Address - Street 2:STE 210
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-2438
Practice Address - Country:US
Practice Address - Phone:209-834-4165
Practice Address - Fax:925-397-4700
Is Sole Proprietor?:No
Enumeration Date:2007-09-10
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA560921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice