Provider Demographics
NPI:1275600363
Name:BELL, MARY CRAIG (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:CRAIG
Last Name:BELL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 N ELM ST
Mailing Address - Street 2:
Mailing Address - City:TUSKEGEE
Mailing Address - State:AL
Mailing Address - Zip Code:36083-1714
Mailing Address - Country:US
Mailing Address - Phone:334-727-6247
Mailing Address - Fax:334-725-1600
Practice Address - Street 1:302 N ELM ST
Practice Address - Street 2:
Practice Address - City:TUSKEGEE
Practice Address - State:AL
Practice Address - Zip Code:36083-1714
Practice Address - Country:US
Practice Address - Phone:334-727-6247
Practice Address - Fax:334-725-1600
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2012-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL38381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL90670OtherBLUE CROSS BLUE SHIELD
AL008806920Medicaid