Provider Demographics
NPI:1003985532
Name:BELL, HARRY THOMAS (DDS)
Entity Type:Individual
Prefix:
First Name:HARRY
Middle Name:THOMAS
Last Name:BELL
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 1:1701 EDINGTON ST
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-2525
Mailing Address - Country:US
Mailing Address - Phone:269-327-5650
Mailing Address - Fax:224-822-3568
Practice Address - Street 1:24293 TELEGRAPH RD STE 212
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-7903
Practice Address - Country:US
Practice Address - Phone:248-223-5639
Practice Address - Fax:248-223-5689
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010163611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4911389Medicaid
MID800438OtherBLUE CROSS BLUE SHEILD NU