Provider Demographics
NPI:1659771079
Name:BLUE TOOTH DENTAL DR PRADEEP BEKAL LLC
Entity Type:Organization
Organization Name:BLUE TOOTH DENTAL DR PRADEEP BEKAL LLC
Other - Org Name:BRILLIANT TOOTH DENTIST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PRADEEP
Authorized Official - Middle Name:P
Authorized Official - Last Name:BEKAL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:937-286-3500
Mailing Address - Street 1:1203 SALEM AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45406-5044
Mailing Address - Country:US
Mailing Address - Phone:937-275-7448
Mailing Address - Fax:937-813-2278
Practice Address - Street 1:1203 SALEM AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45406-5044
Practice Address - Country:US
Practice Address - Phone:937-275-7448
Practice Address - Fax:937-813-2278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-04
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-021117122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty