Provider Demographics
NPI:1740569607
Name:BELLA BELLA DENTAL GROUP
Entity Type:Organization
Organization Name:BELLA BELLA DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LIEN
Authorized Official - Middle Name:T
Authorized Official - Last Name:VAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:352-241-8471
Mailing Address - Street 1:3185 CITRUS TOWER BLVD
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711
Mailing Address - Country:US
Mailing Address - Phone:352-241-8471
Mailing Address - Fax:352-241-8472
Practice Address - Street 1:3185 CITRUS TOWER BLVD
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711
Practice Address - Country:US
Practice Address - Phone:352-241-8471
Practice Address - Fax:352-241-8472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-10
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty