Provider Demographics
NPI:1164800504
Name:BELLEFONTAINE SMILES SMITH A.M. REDDY DDS INC
Entity Type:Organization
Organization Name:BELLEFONTAINE SMILES SMITH A.M. REDDY DDS INC
Other - Org Name:BELLE SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SMITHA
Authorized Official - Middle Name:M
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:614-843-1953
Mailing Address - Street 1:8518 STONECHAT LOOP
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-8625
Mailing Address - Country:US
Mailing Address - Phone:614-843-1953
Mailing Address - Fax:614-737-0644
Practice Address - Street 1:661 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BELLEFONTAINE
Practice Address - State:OH
Practice Address - Zip Code:43311-1725
Practice Address - Country:US
Practice Address - Phone:937-592-7070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-18
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH22578302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization