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NPI Code Detail

MEDICARE: BELLA VITA DENTAL

MEDICARE: BELLA VITA DENTAL
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1305S00000XPoint of Service25737TX

General Provider Information

NPI Number : 1164789558
Entity Type Code : Organization
Provider Name (Legal Business Name) : BELLA VITA DENTAL
Provider Business Mailing Address
First Line : 8410 FONDREN RD
Second Line :
City : HOUSTON
State : TX
Zip : 77074-5616
Country : US
Telephone Number : 713-772-2676
Fax Number : 713-772-2678
Provider Business Practice Location Address
First Line : 8410 FONDREN RD
Second Line :
City : HOUSTON
State : TX
Zip : 77074-5616
Country : US
Telephone Number : 713-772-2676
Fax Number : 713-772-2678
Authorized Official
Title or Position : OWNER
Name : DR. AKUDO L EKWEM
Credential : DDS
Telephone Number : 713-772-2676
Provider Enumeration Date : 04/23/2012
Last Update Date : 04/23/2012

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Directions to “BELLA VITA DENTAL ” Practice Location

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