Provider Demographics
NPI:1336679521
Name:BELL, MIKAL ISMAIL (DMD)
Entity Type:Individual
Prefix:DR
First Name:MIKAL
Middle Name:ISMAIL
Last Name:BELL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 WESTMINSTER
Mailing Address - Street 2:
Mailing Address - City:GLEN CARBON
Mailing Address - State:IL
Mailing Address - Zip Code:62034-1948
Mailing Address - Country:US
Mailing Address - Phone:773-682-8035
Mailing Address - Fax:
Practice Address - Street 1:3394 MCKELVEY RD STE 110
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-2531
Practice Address - Country:US
Practice Address - Phone:314-739-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-19
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20170185171223G0001X
IL0190311771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice