Provider Demographics
NPI:1003301177
Name:BELL FAMILY DENTISTRY, PC
Entity Type:Organization
Organization Name:BELL FAMILY DENTISTRY, PC
Other - Org Name:BRENT BELL DDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-604-0353
Mailing Address - Street 1:2754 TOPEKA ST
Mailing Address - Street 2:
Mailing Address - City:RIVERBANK
Mailing Address - State:CA
Mailing Address - Zip Code:95367-2251
Mailing Address - Country:US
Mailing Address - Phone:209-869-4505
Mailing Address - Fax:
Practice Address - Street 1:2754 TOPEKA ST
Practice Address - Street 2:
Practice Address - City:RIVERBANK
Practice Address - State:CA
Practice Address - Zip Code:95367-2251
Practice Address - Country:US
Practice Address - Phone:209-869-4505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-29
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42120122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty