# BELLA SMILES INC

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

## Provider details

- **NPI number:** 1720117062
- **Authorized official:** MRS. LORETTA R FUDZINSKI R.D.H. (CHIEF EXECUTIVE OFFICER)
- **Authorized official phone:** (505) 299-6112

## Contact information

- **Practice address:** 9204 MENAUL BLVD NE, SUITE 3, ALBUQUERQUE, NM 87112-2256
- **Practice address phone:** (505) 299-6112
- **Practice address fax:** (505) 299-7718
- **Mailing address:** 9204 MENAUL BLVD NE, SUITE 3, ALBUQUERQUE, NM 87112-2256
- **Mailing address phone:** (505) 299-6112
- **Mailing address fax:** (505) 299-7718

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | DH1036 | NM | Yes |

## Other

- **Enumeration date:** 03/04/2007
- **Last updated:** 08/22/2020