Provider Demographics
NPI:1821781774
Name:BOBADILLA BELLO, LINA FERNANDA (DMD)
Entity Type:Individual
Prefix:DR
First Name:LINA
Middle Name:FERNANDA
Last Name:BOBADILLA BELLO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23490 BLUEMONT CHAPEL TER
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20148-6300
Mailing Address - Country:US
Mailing Address - Phone:832-591-8570
Mailing Address - Fax:
Practice Address - Street 1:23490 BLUEMONT CHAPEL TER
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20148-6300
Practice Address - Country:US
Practice Address - Phone:832-591-8570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-29
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401418434122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist