# BELLEFONTE FAMILY DENTAL CARE, PSC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1285910406
- **Authorized official:** LISA RENEE DEAN DMD (OWNER)
- **Authorized official phone:** (606) 836-9962

## Contact information

- **Practice address:** 1592 DIEDERICH BLVD, RUSSELL, KY 41169-1676
- **Practice address phone:** (606) 836-9962
- **Practice address fax:** (606) 836-4668
- **Mailing address:** 1592 DIEDERICH BLVD, RUSSELL, KY 41169-1676
- **Mailing address phone:** (606) 836-9962
- **Mailing address fax:** (606) 836-4668

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 6890 | KY | Yes |

## Other

- **Enumeration date:** 11/02/2011
- **Last updated:** 11/02/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 60068905 | — | KY |