Provider Demographics
NPI:1144557281
Name:BELLO, ADESUWA B (DDS)
Entity type:Individual
Prefix:
First Name:ADESUWA
Middle Name:B
Last Name:BELLO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:ADESUWA
Other - Middle Name:
Other - Last Name:OSUNDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1601 PRECISION PARK LN
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92173-1345
Mailing Address - Country:US
Mailing Address - Phone:619-662-4100
Mailing Address - Fax:
Practice Address - Street 1:3177 OCEAN VIEW BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92113-1432
Practice Address - Country:US
Practice Address - Phone:619-662-4100
Practice Address - Fax:619-232-5922
Is Sole Proprietor?:No
Enumeration Date:2009-11-10
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58654122300000X
NY057126122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04507282Medicaid
NY057126OtherLICENSE