Provider Demographics
NPI:1700952421
Name:BELLO, IRMA A (DDS)
Entity Type:Individual
Prefix:DR
First Name:IRMA
Middle Name:A
Last Name:BELLO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 LIBERTY SQUARE
Mailing Address - Street 2:
Mailing Address - City:STONY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:10980
Mailing Address - Country:US
Mailing Address - Phone:845-429-1293
Mailing Address - Fax:845-429-0215
Practice Address - Street 1:17 LIBERTY SQ
Practice Address - Street 2:
Practice Address - City:STONY POINT
Practice Address - State:NY
Practice Address - Zip Code:10980
Practice Address - Country:US
Practice Address - Phone:845-429-1293
Practice Address - Fax:845-429-0215
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0438671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01284399Medicaid