Provider Demographics
NPI:1225252687
Name:BELL, GREGORY BRADFORD (DDS)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:BRADFORD
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 1:676 NO. MICHIGAN AVE. SUITE 3500
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611
Mailing Address - Country:US
Mailing Address - Phone:312-918-1150
Mailing Address - Fax:312-274-3334
Practice Address - Street 1:676 NO. MICHIGAN AVE. #3500
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611
Practice Address - Country:US
Practice Address - Phone:312-918-1150
Practice Address - Fax:312-274-3334
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190220581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL363869310OtherSTATE TAX NUMBER