Healthcare Provider Details

I. General information

NPI: 1558265678
Provider Name (Legal Business Name): BELLDENT SERVICE REPAIR INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2026
Last Update Date: 10/03/2026
Certification Date: 10/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 HAVEN AVE
PORT WASHINGTON NY
11050-3625
US

IV. Provider business mailing address

18 HAVEN AVE
PORT WASHINGTON NY
11050-3625
US

V. Phone/Fax

Practice location:
  • Phone: 516-643-7272
  • Fax:
Mailing address:
  • Phone: 516-643-7272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. MICHEAL KOKOLIS
Title or Position: PRESIDENT
Credential: DDS
Phone: 516-643-7272