Provider Demographics
NPI:1982843900
Name:ANTIOQUIA, BELLA MARIA EDEJER (DMD)
Entity Type:Individual
Prefix:DR
First Name:BELLA MARIA
Middle Name:EDEJER
Last Name:ANTIOQUIA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:BELLA
Other - Middle Name:EDEJER
Other - Last Name:ANTIOQUIA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1727 SWEETWATER RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950
Mailing Address - Country:US
Mailing Address - Phone:619-477-0045
Mailing Address - Fax:619-477-5822
Practice Address - Street 1:1727 SWEETWATER RD
Practice Address - Street 2:SUITE 110
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950
Practice Address - Country:US
Practice Address - Phone:619-477-0045
Practice Address - Fax:619-477-5822
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-13
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46737122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist