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General NPI Number Information
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NPI Number | 1376760033
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Entity Type | Organization
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Legal Business Name | BELLA DENTAL, PLLC
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Dates
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Enumeration Date | 04/20/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5516 FRY ROAD
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City | KATY
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State | TX
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Zip | 77449-5746
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Country | US
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Telephone | 281-859-7777
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Fax | 281-656-2205
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Provider Business Mailing Address
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Address Line | 5516 FRY ROAD
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City | KATY
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State | TX
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Zip | 77449-5746
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Country | US
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Telephone | 281-859-7777
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Fax | 281-656-2205
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Authorized Official
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Title or Position | PRESIDENT
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Name | FATEMEH BIJAN
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Credential | DDS
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Telephone | 281-859-7777
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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 | 19864
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 20413
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 08554
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License Number State | TX
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