# BELL PARK DENTAL LLC

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

## Provider details

- **NPI number:** 1457474926
- **Authorized official:** HOLLY BOTSHEKAN DENTIST (DENTIST)
- **Authorized official phone:** (602) 896-9688

## Contact information

- **Practice address:** 17037 N 43RD AVE STE A4, GLENDALE, AZ 85308-4026
- **Practice address phone:** (602) 896-9688
- **Practice address fax:** (602) 896-9633
- **Mailing address:** 17037 N 43RD AVE STE A4, GLENDALE, AZ 85308-4026
- **Mailing address phone:** (602) 896-9688
- **Mailing address fax:** (602) 896-9633

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 4397 | AZ | Yes |

## Other

- **Enumeration date:** 04/09/2007
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 357980 | RAMIN DAMADZADEH AHCCCS | AZ |
| 01 | — | 408527 | HOLLY BOTSHEKAN AHCCCS | AZ |