Provider Demographics
NPI:1861836801
Name:BELLAIRE DENTAL HEALTH CENTER, P.C.
Entity Type:Organization
Organization Name:BELLAIRE DENTAL HEALTH CENTER, P.C.
Other - Org Name:WILD SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-668-5437
Mailing Address - Street 1:5720 BELLAIRE BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77081-5514
Mailing Address - Country:US
Mailing Address - Phone:713-668-5437
Mailing Address - Fax:
Practice Address - Street 1:5720 BELLAIRE BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77081-5514
Practice Address - Country:US
Practice Address - Phone:713-668-5437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-22
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX172871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty