Organization
BELLA VISTA DENTAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN ALEXANDER KENNEDY JR. DMD (PRESIDENT)
(864) 386-2753
Entity
Organization
Contact information
Practice address
2498 N PLEASANTBURG DR, SUITE C, GREENVILLE, SC 29609-2730
(864) 386-2753
Mailing address
PO BOX 31625, GREENVILLE, SC 29608-1625
(864) 386-2753
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4377
SC
Other
Enumeration date
02/21/2015
Last updated
02/21/2015
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