Provider Demographics
NPI:1164183562
Name:BELL PEDIATRIC DENTISTRY & ORTHODONTICS PLLC
Entity Type:Organization
Organization Name:BELL PEDIATRIC DENTISTRY & ORTHODONTICS PLLC
Other - Org Name:IVY CITY PEDIATRIC DENTISTRY & ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:DR
Authorized Official - First Name:JARRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:CALDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:202-669-6571
Mailing Address - Street 1:715 INGRAHAM ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-7707
Mailing Address - Country:US
Mailing Address - Phone:202-669-6571
Mailing Address - Fax:
Practice Address - Street 1:2012 HECHT AVE NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-1668
Practice Address - Country:US
Practice Address - Phone:202-669-6571
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-07
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC037888331Medicaid
MD086310600Medicaid