Provider Demographics
NPI:1508182510
Name:BELLA DENTAL, INC.
Entity Type:Organization
Organization Name:BELLA DENTAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:OH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:510-483-2670
Mailing Address - Street 1:250 JUANA AVE
Mailing Address - Street 2:STE 102
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-4841
Mailing Address - Country:US
Mailing Address - Phone:510-483-2670
Mailing Address - Fax:510-483-1566
Practice Address - Street 1:250 JUANA AVE
Practice Address - Street 2:STE 102
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-4841
Practice Address - Country:US
Practice Address - Phone:510-483-2670
Practice Address - Fax:510-483-1566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-15
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57905261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental