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
StateLicense IDTaxonomies
FLDN93361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty