Provider Demographics
NPI:1124522297
Name:BELLISSIMO DENTISTRY, PLLC
Entity type:Organization
Organization Name:BELLISSIMO DENTISTRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:BJERKE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:602-412-8648
Mailing Address - Street 1:2815 E. OCOTILLO RD.
Mailing Address - Street 2:STE. #3
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249
Mailing Address - Country:US
Mailing Address - Phone:480-935-5900
Mailing Address - Fax:480-935-5901
Practice Address - Street 1:2815 E. OCOTILLO RD.
Practice Address - Street 2:STE. #3
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85249
Practice Address - Country:US
Practice Address - Phone:480-935-5900
Practice Address - Fax:480-935-5901
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BELLISSIMO DENTISTRY, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-03-22
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ90341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty