Provider Demographics
NPI:1942359997
Name:THOMAS W. BELL, JR., DDS AND EDWARD G. COVERT, DDS, DME
Entity Type:Organization
Organization Name:THOMAS W. BELL, JR., DDS AND EDWARD G. COVERT, DDS, DME
Other - Org Name:FAMILY COMPREHENSIVE & COSMETIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:ORR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-353-5171
Mailing Address - Street 1:400 DOLPHIN DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-5291
Mailing Address - Country:US
Mailing Address - Phone:910-353-5171
Mailing Address - Fax:910-353-8810
Practice Address - Street 1:400 DOLPHIN DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546
Practice Address - Country:US
Practice Address - Phone:910-353-5171
Practice Address - Fax:910-353-8810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5694122300000X
NC66621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5905672Medicaid
NC8990604Medicaid
NC5905672Medicaid