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General NPI Number Information
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NPI Number | 1205624749
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Entity Type | Organization
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Legal Business Name | WALLACE J BELLAMY DMD
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Dates
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Enumeration Date | 04/25/2025
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Last Update Date | 04/25/2025
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Provider Practice Location Address
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Address Line | 8007 LAGUNA BLVD SUITE 3
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City | ELK GROVE
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State | CA
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Zip | 95758
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Country | US
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Telephone | 916-683-3011
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Fax |
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Provider Business Mailing Address
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Address Line | 4170 TRUXEL ROAD SUITE C
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City | SACRAMENTO
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State | CA
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Zip | 95834
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO/PRESIDENT
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Name | JAGDEV HEIR
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Credential |
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Telephone | 518-441-5483
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223D0001X
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Taxonomy Name | Public Health Dentistry
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License Number |
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License Number State |
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