Provider Demographics
NPI:1487661153
Name:BELL, CLIFFORD RANDALL (DDS)
Entity Type:Individual
Prefix:DR
First Name:CLIFFORD
Middle Name:RANDALL
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 1:3308 FM 2495
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TX
Mailing Address - Zip Code:75752-7005
Mailing Address - Country:US
Mailing Address - Phone:713-203-2103
Mailing Address - Fax:
Practice Address - Street 1:208 CRESTWAY ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TX
Practice Address - Zip Code:75751-2117
Practice Address - Country:US
Practice Address - Phone:713-203-2103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX741946583OtherDDS