Provider Demographics
NPI:1164554168
Name:BELLEVUE DENTAL CARE, PC
Entity Type:Organization
Organization Name:BELLEVUE DENTAL CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:GROSS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:615-662-7878
Mailing Address - Street 1:7041 HIGHWAY 70 S
Mailing Address - Street 2:SUITE 106
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37221-5238
Mailing Address - Country:US
Mailing Address - Phone:615-662-7878
Mailing Address - Fax:615-662-9919
Practice Address - Street 1:7041 HIGHWAY 70 S
Practice Address - Street 2:SUITE 106
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37221-5238
Practice Address - Country:US
Practice Address - Phone:615-662-7878
Practice Address - Fax:615-662-9919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN70021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty