Provider Demographics
NPI:1780743179
Name:BELLINGER, AUDREA LAVERN (DDS)
Entity type:Individual
Prefix:
First Name:AUDREA
Middle Name:LAVERN
Last Name:BELLINGER
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 1:5002 CREEKBEND DR.
Mailing Address - Street 2:SUITE 550
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77035
Mailing Address - Country:US
Mailing Address - Phone:713-489-3454
Mailing Address - Fax:
Practice Address - Street 1:10804 S. POST OAK RD
Practice Address - Street 2:SUITE 100
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77035
Practice Address - Country:US
Practice Address - Phone:713-489-3454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX208591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice