Provider Demographics
NPI:1154473189
Name:WILLIAM J & KATHLEEN E BELLAMY PTR
Entity Type:Organization
Organization Name:WILLIAM J & KATHLEEN E BELLAMY PTR
Other - Org Name:CHESTER CREEK DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:BELLAMY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:218-724-1332
Mailing Address - Street 1:1324 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55805-2403
Mailing Address - Country:US
Mailing Address - Phone:218-724-1332
Mailing Address - Fax:218-724-2184
Practice Address - Street 1:1324 E 1ST ST
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55805-2403
Practice Address - Country:US
Practice Address - Phone:218-724-1332
Practice Address - Fax:218-724-2184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND9789 D97951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty