Provider Demographics
NPI: | 1770685091 |
---|---|
Name: | BELLEVIEW DENTAL CENTER, INC |
Entity Type: | Organization |
Organization Name: | BELLEVIEW DENTAL CENTER, INC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | SECRETARY |
Authorized Official - Prefix: | |
Authorized Official - First Name: | CARLA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | SWEENY |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 352-288-0703 |
Mailing Address - Street 1: | 10860 SE COUNTY ROAD 25 |
Mailing Address - Street 2: | |
Mailing Address - City: | BELLEVIEW |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 34420 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 352-288-0703 |
Mailing Address - Fax: | 352-288-2373 |
Practice Address - Street 1: | 10600 SE HIGHWAY 441 |
Practice Address - Street 2: | |
Practice Address - City: | BELLEVIEW |
Practice Address - State: | FL |
Practice Address - Zip Code: | 34420 |
Practice Address - Country: | US |
Practice Address - Phone: | 352-245-1188 |
Practice Address - Fax: | 352-245-1107 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-09-05 |
Last Update Date: | 2020-08-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
FL | DN9336 | 1223G0001X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 1223G0001X | Dental Providers | Dentist | General Practice | Group - Single Specialty |