Provider Demographics
NPI:1972709939
Name:BELLACK, HARLEY SCOTT (DDS)
Entity Type:Individual
Prefix:DR
First Name:HARLEY
Middle Name:SCOTT
Last Name:BELLACK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 E BAY DR
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33771-2468
Mailing Address - Country:US
Mailing Address - Phone:727-536-3400
Mailing Address - Fax:727-532-3016
Practice Address - Street 1:2700 E BAY DR
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771-2468
Practice Address - Country:US
Practice Address - Phone:727-536-3400
Practice Address - Fax:727-532-3016
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL115611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice