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General NPI Number Information
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NPI Number | 1720372899
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Entity Type | Organization
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Legal Business Name | BELLEFONTAINE DENTAL, MARK R. BEDFORD, DDS, LLC
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Dates
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Enumeration Date | 06/06/2011
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Last Update Date | 06/06/2011
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Provider Practice Location Address
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Address Line | 4 W MAIN ST SUITE 908
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City | SPRINGFIELD
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State | OH
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Zip | 45502-1300
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Country | US
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Telephone | 937-322-7832
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Fax | 937-322-7946
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Provider Business Mailing Address
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Address Line | 137 W CHILLICOTHE AVE
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City | BELLEFONTAINE
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State | OH
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Zip | 43311-1472
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Country | US
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Telephone | 937-592-1776
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Fax | 937-592-4566
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | KATHY S NELSON
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Credential |
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Telephone | 937-206-4080
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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 | 15902
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License Number State | OH
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