Provider Demographics
NPI:1477212421
Name:BELLASERA FAMILY DENTISTRY
Entity Type:Organization
Organization Name:BELLASERA FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:HUKILL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:704-321-7929
Mailing Address - Street 1:3041 SENNA DR
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-6727
Mailing Address - Country:US
Mailing Address - Phone:704-321-7929
Mailing Address - Fax:704-321-2908
Practice Address - Street 1:3041 SENNA DR
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-6727
Practice Address - Country:US
Practice Address - Phone:704-321-7929
Practice Address - Fax:704-321-2908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-16
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty