Organization
BELLA VISTA DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD VICTOR EIDELSON DDS, FAGD (PRESIDENT DENTIST)
(215) 627-1995
Entity
Organization
Contact information
Practice address
1046 SOUTH ST, 1ST FLOOR, PHILADELPHIA, PA 19147-1935
(215) 627-1995
(215) 557-0799
Mailing address
1601 WALNUT ST, SUITE 1207, PHILADELPHIA, PA 19102-2944
(215) 557-6668
(215) 557-0799
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DS019673L
PA
Other
Enumeration date
05/31/2007
Last updated
08/21/2007
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