MEDICARE: BELLA DENTAL 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
1	122300000X	Dentist

General Provider Information

NPI Number	:	1790937753
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BELLA DENTAL LLC

Provider Business Mailing Address
First Line	:	1825 S NELLIS BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-6215
Country	:	US
Telephone Number	:	702-452-3552
Fax Number	:	702-452-0088

Provider Business Practice Location Address
First Line	:	1825 S NELLIS BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-6215
Country	:	US
Telephone Number	:	702-452-3552
Fax Number	:	702-452-0088

Authorized Official
Title or Position	:	DENTIST/OWNER
Name	:	ADRIAN RAMSEY RUIZ
Credential	:	DDS
Telephone Number	:	702-452-3552

Provider Enumeration Date	:	10/21/2008
Last Update Date	:	10/21/2008

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Directions to “BELLA DENTAL LLC ” Practice Location

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