Provider Demographics
NPI:1710575485
Name:BELLA FAMILY DENTISTRY PLLC
Entity Type:Organization
Organization Name:BELLA FAMILY DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMAL
Authorized Official - Middle Name:F
Authorized Official - Last Name:KHATIB
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:682-326-0186
Mailing Address - Street 1:5159 WICHITA ST STE 170
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76119-5686
Mailing Address - Country:US
Mailing Address - Phone:682-326-0186
Mailing Address - Fax:
Practice Address - Street 1:5159 WICHITA ST STE 170
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76119-5686
Practice Address - Country:US
Practice Address - Phone:682-326-0186
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-07
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty