Provider Demographics
NPI:1407152259
Name:BELLA DENTAL SERVICES, P.C
Entity Type:Organization
Organization Name:BELLA DENTAL SERVICES, P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RODERICK
Authorized Official - Middle Name:SAMPSON
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:404-294-8385
Mailing Address - Street 1:4122 E PONCE DE LEON AVE
Mailing Address - Street 2:SUITE #5
Mailing Address - City:CLARKSTON
Mailing Address - State:GA
Mailing Address - Zip Code:30021
Mailing Address - Country:US
Mailing Address - Phone:404-294-8385
Mailing Address - Fax:
Practice Address - Street 1:4122 E PONCE DE LEON AVE
Practice Address - Street 2:SUITE #5
Practice Address - City:CLARKSTON
Practice Address - State:GA
Practice Address - Zip Code:30021-1838
Practice Address - Country:US
Practice Address - Phone:404-294-8385
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-26
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADNO13198122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty