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Organization

BELLEFONTE FAMILY DENTAL CARE, PSC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
LISA RENEE DEAN DMD (OWNER)
(606) 836-9962
Entity
Organization

Contact information

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

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6890
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
60068905
KY
Enumeration date
11/02/2011
Last updated
11/02/2011
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