Provider Demographics
NPI:1770200354
Name:BELLAM DENTAL CORPORATION
Entity type:Organization
Organization Name:BELLAM DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MAMATHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BELLAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-364-4460
Mailing Address - Street 1:7332 THORNTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:CA
Mailing Address - Zip Code:94560-3647
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7332 THORNTON AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:CA
Practice Address - Zip Code:94560-3647
Practice Address - Country:US
Practice Address - Phone:510-796-3333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental