Healthcare Provider Details

I. General information

NPI: 1427431154
Provider Name (Legal Business Name): ADAM BELLACK D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2015
Last Update Date: 09/14/2022
Certification Date: 09/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9515 W CAMELBACK RD STE 122
PHOENIX AZ
85037-1365
US

IV. Provider business mailing address

1400 PELHAM PKWY S
BRONX NY
10461-1138
US

V. Phone/Fax

Practice location:
  • Phone: 623-846-7557
  • Fax:
Mailing address:
  • Phone: 718-918-3419
  • Fax: 718-918-6147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberD011350
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: