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NPI Code Detail

MEDICARE: BLUE TOOTH DENTAL DR PRADEEP BEKAL LLC

MEDICARE: BLUE TOOTH DENTAL DR PRADEEP BEKAL LLC
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
1122300000XDentist30-021117OH

General Provider Information

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

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