Provider Demographics
NPI:1710482203
Name:BELLEVUE DENTAL PARTNERS PLLC
Entity Type:Organization
Organization Name:BELLEVUE DENTAL PARTNERS PLLC
Other - Org Name:BELLEVUE DENTAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INSURANCE BILLER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SNOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-734-3664
Mailing Address - Street 1:539 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:PA
Mailing Address - Zip Code:15202-3548
Mailing Address - Country:US
Mailing Address - Phone:412-734-3664
Mailing Address - Fax:412-734-3998
Practice Address - Street 1:539 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:PA
Practice Address - Zip Code:15202-3548
Practice Address - Country:US
Practice Address - Phone:412-734-3664
Practice Address - Fax:412-734-3998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-27
Last Update Date:2018-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS020662L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty