Provider Demographics
NPI:1053458620
Name:BELL, BRENT M (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:M
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 1:2754 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:209-869-4568
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:209-869-4568
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA421201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice