Provider Demographics
NPI:1780725523
Name:BELLO-BURGOS, TERESA J (DMD, DDS)
Entity type:Individual
Prefix:DR
First Name:TERESA
Middle Name:J
Last Name:BELLO-BURGOS
Suffix:
Gender:F
Credentials:DMD, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12095 NW 5TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33182-1343
Mailing Address - Country:US
Mailing Address - Phone:305-559-0051
Mailing Address - Fax:305-553-5980
Practice Address - Street 1:14252 SW 8 ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33184-3057
Practice Address - Country:US
Practice Address - Phone:305-553-5980
Practice Address - Fax:305-553-5981
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN156251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDN15625OtherDENTAL LICENCE
FLDN15625OtherDENTAL LICENCE
FL201355299OtherTIN