Provider Demographics
NPI:1649484353
Name:BELLIDO-GRIFFIN, ROSA (DMD)
Entity type:Individual
Prefix:DR
First Name:ROSA
Middle Name:
Last Name:BELLIDO-GRIFFIN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4446 N WESTERN AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-2175
Mailing Address - Country:US
Mailing Address - Phone:872-208-5240
Mailing Address - Fax:872-208-5051
Practice Address - Street 1:4446 N WESTERN AVE STE 1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-2175
Practice Address - Country:US
Practice Address - Phone:872-208-5240
Practice Address - Fax:872-208-5051
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3392122300000X
IL019022398122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30303708Medicaid
IL1001185Medicaid