Provider Demographics
NPI:1902388044
Name:BELA OF WEST COLUMBIA
Entity Type:Organization
Organization Name:BELA OF WEST COLUMBIA
Other - Org Name:BELA FAMILY DENTISTRY OF WEST COLUMBIA
Other - Org Type:Other Name
Authorized Official - Title/Position:PRACTICE FACILLITATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SWEGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-736-7146
Mailing Address - Street 1:PO BOX 1664
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29071-1664
Mailing Address - Country:US
Mailing Address - Phone:803-292-1927
Mailing Address - Fax:
Practice Address - Street 1:1109 B AVE
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-6722
Practice Address - Country:US
Practice Address - Phone:803-292-1927
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-05
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty