Provider Demographics
NPI:1730695529
Name:BELLBROOK PEDIATRIC DENTISTRY, INC.
Entity type:Organization
Organization Name:BELLBROOK PEDIATRIC DENTISTRY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:YISSELL
Authorized Official - Middle Name:
Authorized Official - Last Name:CARPENTINO- DE JESUS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:937-848-4848
Mailing Address - Street 1:4354 W FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:BELLBROOK
Mailing Address - State:OH
Mailing Address - Zip Code:45305-1544
Mailing Address - Country:US
Mailing Address - Phone:937-848-4848
Mailing Address - Fax:937-848-4849
Practice Address - Street 1:4354 W FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:BELLBROOK
Practice Address - State:OH
Practice Address - Zip Code:45305-1544
Practice Address - Country:US
Practice Address - Phone:937-848-4848
Practice Address - Fax:937-848-4849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-17
Last Update Date:2017-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300238251223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty