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General NPI Number Information
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NPI Number | 1669282505
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Entity Type | Organization
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Legal Business Name | BELLA VISTA DENTAL, PLLC
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Dates
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Enumeration Date | 01/13/2025
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Last Update Date | 01/13/2025
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Provider Practice Location Address
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Address Line | 317 S STATE HIGHWAY 46
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City | SEGUIN
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State | TX
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Zip | 78155-7506
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Country | US
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Telephone | 830-379-8902
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Fax |
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Provider Business Mailing Address
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Address Line | 317 S STATE HIGHWAY 46
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City | SEGUIN
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State | TX
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Zip | 78155-7506
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Country | US
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Telephone | 830-379-8902
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Fax |
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Authorized Official
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Title or Position | OWNER DENTIST
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Name | TRAVIS QUINTANILLA
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Credential | DDS
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Telephone | 210-416-0332
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State | NULL
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