Provider Demographics
NPI:1124035498
Name:BELL, JUSTIN DENNIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:DENNIS
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 1:577 HOLLADAY CIR
Mailing Address - Street 2:
Mailing Address - City:AMMON
Mailing Address - State:ID
Mailing Address - Zip Code:83406-4800
Mailing Address - Country:US
Mailing Address - Phone:208-528-2474
Mailing Address - Fax:208-523-4441
Practice Address - Street 1:2205 CHANNING WAY
Practice Address - Street 2:SUITE A
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-8016
Practice Address - Country:US
Practice Address - Phone:208-529-4484
Practice Address - Fax:208-523-4441
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD34641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID6D923OtherBLUE CROSS ID