Provider Demographics
NPI:1942403936
Name:BELLMONT, MARI (DDS)
Entity Type:Individual
Prefix:
First Name:MARI
Middle Name:
Last Name:BELLMONT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4640 NICOLS RD
Mailing Address - Street 2:100
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-2306
Mailing Address - Country:US
Mailing Address - Phone:651-454-1414
Mailing Address - Fax:651-454-7987
Practice Address - Street 1:4640 NICOLS RD
Practice Address - Street 2:100
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-2306
Practice Address - Country:US
Practice Address - Phone:651-454-1414
Practice Address - Fax:651-454-7987
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND12392122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist