Provider Demographics
NPI:1235675430
Name:BELL ROAD DENTAL CARE PLLC
Entity type:Organization
Organization Name:BELL ROAD DENTAL CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DMD
Authorized Official - Prefix:DR
Authorized Official - First Name:REZA
Authorized Official - Middle Name:
Authorized Official - Last Name:JAFARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-404-3483
Mailing Address - Street 1:702 E BELL RD
Mailing Address - Street 2:STE. 118
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-6639
Mailing Address - Country:US
Mailing Address - Phone:602-404-3483
Mailing Address - Fax:602-404-3491
Practice Address - Street 1:702 E BELL RD
Practice Address - Street 2:STE. 118
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-6639
Practice Address - Country:US
Practice Address - Phone:602-404-3483
Practice Address - Fax:602-404-3491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-11
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ63851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty