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General NPI Number Information
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NPI Number | 1659771079
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Entity Type | Organization
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Legal Business Name | BLUE TOOTH DENTAL DR PRADEEP BEKAL LLC
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Dates
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Enumeration Date | 09/04/2014
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Last Update Date | 09/04/2014
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Provider Practice Location Address
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Address Line | 1203 SALEM AVE
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City | DAYTON
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State | OH
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Zip | 45406-5044
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Country | US
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Telephone | 937-275-7448
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Fax | 937-813-2278
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Provider Business Mailing Address
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Address Line | 1203 SALEM AVE
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City | DAYTON
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State | OH
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Zip | 45406-5044
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Country | US
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Telephone | 937-275-7448
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Fax | 937-813-2278
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Authorized Official
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Title or Position | DENTIST
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Name | DR. PRADEEP P BEKAL
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Credential | DDS
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Telephone | 937-286-3500
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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 | 30-021117
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License Number State | OH
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