Provider Demographics
NPI:1407397581
Name:MATTHEW BELLAFIORE DDS PC
Entity type:Organization
Organization Name:MATTHEW BELLAFIORE DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:L
Authorized Official - Last Name:BELLAFIORE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-875-9424
Mailing Address - Street 1:185 MONTAGUE ST FL 3
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-3608
Mailing Address - Country:US
Mailing Address - Phone:718-875-9424
Mailing Address - Fax:718-875-2630
Practice Address - Street 1:185 MONTAGUE ST # F3
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:01121-3608
Practice Address - Country:US
Practice Address - Phone:718-875-9424
Practice Address - Fax:718-875-2630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-09
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043328261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental