Provider Demographics
NPI:1922464718
Name:BELLA DENTAL WEST TEXAS, PLLC
Entity Type:Organization
Organization Name:BELLA DENTAL WEST TEXAS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:NAVA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:432-837-4321
Mailing Address - Street 1:102 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:ALPINE
Mailing Address - State:TX
Mailing Address - Zip Code:79830-4606
Mailing Address - Country:US
Mailing Address - Phone:432-837-4321
Mailing Address - Fax:432-837-4322
Practice Address - Street 1:102 N 7TH ST
Practice Address - Street 2:
Practice Address - City:ALPINE
Practice Address - State:TX
Practice Address - Zip Code:79830-4606
Practice Address - Country:US
Practice Address - Phone:432-837-4321
Practice Address - Fax:432-837-4322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-08
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19211261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX090782612Medicaid