Provider Demographics
NPI:1144621251
Name:BELLAM, KRANTIKUMARI
Entity Type:Individual
Prefix:
First Name:KRANTIKUMARI
Middle Name:
Last Name:BELLAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 JUAN TABO BLVD NE STE Q
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87123-1444
Mailing Address - Country:US
Mailing Address - Phone:781-708-6656
Mailing Address - Fax:
Practice Address - Street 1:800 JUAN TABO BLVD NE STE Q
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87123-1444
Practice Address - Country:US
Practice Address - Phone:781-708-6656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-08
Last Update Date:2023-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD43441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice