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General NPI Number Information
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NPI Number | 1487869749
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Entity Type | Organization
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Legal Business Name | BELL BLVD. DENTAL, P.C.
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Dates
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Enumeration Date | 05/11/2007
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Last Update Date | 10/03/2011
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Provider Practice Location Address
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Address Line | 46-01 BELL BLVD
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City | BAYSIDE
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State | NY
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Zip | 11361
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Country | US
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Telephone | 718-281-2222
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Fax | 718-281-2822
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Provider Business Mailing Address
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Address Line | 46-01 BELL BLVD.
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City | BAYSIDE
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State | NY
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Zip | 11361
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Country | US
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Telephone | 718-281-2222
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Fax | 718-281-2822
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Authorized Official
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Title or Position | DENTIST
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Name | JUN S SONG
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Credential | DDS,MMSC
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Telephone | 718-281-2222
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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 | 047747
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 054688
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 048958
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 048211
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License Number State | NY
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