MEDICARE: BELLA SMILE DENTAL PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center	048850	NY

General Provider Information

NPI Number	:	1558533505
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BELLA SMILE DENTAL PLLC

Provider Business Mailing Address
First Line	:	3712 90TH ST
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-7862
Country	:	US
Telephone Number	:	718-429-5550
Fax Number	:

Provider Business Practice Location Address
First Line	:	3712 90TH ST
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-7862
Country	:	US
Telephone Number	:	718-429-5550
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. DORIS NELLY LADINO-ORDONEZ
Credential	:	DDS
Telephone Number	:	718-429-5550

Provider Enumeration Date	:	03/31/2008
Last Update Date	:	03/31/2008

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