Provider Demographics
NPI:1376647842
Name:BELLEVILLE DENTAL CENTER, P.C.
Entity type:Organization
Organization Name:BELLEVILLE DENTAL CENTER, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:M
Authorized Official - Last Name:LLAMERA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:973-751-6600
Mailing Address - Street 1:5 FRANKLIN AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-3532
Mailing Address - Country:US
Mailing Address - Phone:973-751-6600
Mailing Address - Fax:973-751-6364
Practice Address - Street 1:5 FRANKLIN AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-3532
Practice Address - Country:US
Practice Address - Phone:973-751-6600
Practice Address - Fax:973-751-6364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI0190131223G0001X
NJDI0195761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty