Provider Demographics
NPI:1366906190
Name:BELLA VIA DENTAL, PLLC
Entity type:Organization
Organization Name:BELLA VIA DENTAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BUHRLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:480-292-8429
Mailing Address - Street 1:4425 S MOUNTAIN RD STE 106
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85212-7132
Mailing Address - Country:US
Mailing Address - Phone:480-292-8429
Mailing Address - Fax:
Practice Address - Street 1:4425 S MOUNTAIN RD STE 106
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85212-7132
Practice Address - Country:US
Practice Address - Phone:480-292-8429
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-25
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1659412005Medicaid