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General NPI Number Information
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NPI Number | 1184214116
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Entity Type | Organization
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Legal Business Name | BELLEFONTAINE DENTAL PARTNERS LLC
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Dates
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Enumeration Date | 01/23/2021
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Last Update Date | 01/23/2021
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Provider Practice Location Address
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Address Line | 2303 S MAIN ST
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City | BELLEFONTAINE
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State | OH
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Zip | 43311-1566
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Country | US
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Telephone | 937-595-0080
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Fax | 937-595-0080
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Provider Business Mailing Address
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Address Line | 2303 S MAIN ST
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City | BELLEFONTAINE
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State | OH
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Zip | 43311-1566
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Country | US
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Telephone | 937-595-0080
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Fax | 937-595-0080
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Authorized Official
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Title or Position | OWNER
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Name | ERIC MORRISON
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Credential | DDS
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Telephone | 937-595-0080
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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