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General NPI Number Information
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NPI Number | 1396218640
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Entity Type | Organization
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Legal Business Name | BELLA DENTAL OF HOLMDELL, LLC
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Dates
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Enumeration Date | 01/09/2019
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Last Update Date | 01/09/2019
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Provider Practice Location Address
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Address Line | 668 N BEERS ST STE 203
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City | HOLMDEL
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State | NJ
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Zip | 07733-1511
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Country | US
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Telephone | 732-614-5576
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Fax |
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Provider Business Mailing Address
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Address Line | 445 BRICK BLVD STE 307
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City | BRICK
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State | NJ
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Zip | 08723-6080
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Country | US
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Telephone | 732-477-1335
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Fax | 732-920-5758
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Authorized Official
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Title or Position | OWNER
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Name | ALEKSANDR I SHOR
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Credential | DMD
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Telephone | 732-614-5576
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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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