Provider Demographics
NPI:1295813277
Name:BELLANCA, PAUL M (DDS)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:M
Last Name:BELLANCA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95-390 KUAHELANI AVE STE 4E
Mailing Address - Street 2:
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-1190
Mailing Address - Country:US
Mailing Address - Phone:808-623-9881
Mailing Address - Fax:866-701-6294
Practice Address - Street 1:95-390 KUAHELANI AVE STE 4E
Practice Address - Street 2:
Practice Address - City:MILILANI
Practice Address - State:HI
Practice Address - Zip Code:96789-1190
Practice Address - Country:US
Practice Address - Phone:808-623-9881
Practice Address - Fax:866-701-6294
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI8531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice