Provider Demographics
NPI:1790272425
Name:TBD IV, PLLC
Entity Type:Organization
Organization Name:TBD IV, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:BELL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:502-640-3609
Mailing Address - Street 1:10675 N SUMMER MOON PL
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85737-8631
Mailing Address - Country:US
Mailing Address - Phone:502-640-3609
Mailing Address - Fax:520-329-8848
Practice Address - Street 1:750 E PUSCH VIEW LN STE 100
Practice Address - Street 2:
Practice Address - City:ORO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85737-8766
Practice Address - Country:US
Practice Address - Phone:520-797-9524
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-18
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD009150122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty