Healthcare Provider Details

I. General information

NPI: 1285033753
Provider Name (Legal Business Name): BELLA DENTAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2014
Last Update Date: 08/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5787 WINSTON CT
ALEXANDRIA VA
22311-5824
US

IV. Provider business mailing address

5787 WINSTON CT
ALEXANDRIA VA
22311-5824
US

V. Phone/Fax

Practice location:
  • Phone: 703-931-4400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number0401413997
License Number StateVA

VIII. Authorized Official

Name: BEN LIU
Title or Position: OWNER
Credential:
Phone: 703-931-4400