Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 30190 | TX |
NPI | 1023413424 |
---|---|
Provider Name | Dr. Elena Bedilo |
First Address | Aliso Viejo, CA 92656-1759 |
Second Address | Houston, TX 77093-3600 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2014 |
Last Update Date | 07/09/2020 |