Provider Demographics
NPI:1740205434
Name:BELL, JANICE (DMD)
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:
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 1:407 VOSE AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07079-3013
Mailing Address - Country:US
Mailing Address - Phone:201-341-4803
Mailing Address - Fax:
Practice Address - Street 1:21 QUITMAN ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-4105
Practice Address - Country:US
Practice Address - Phone:973-424-4329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI1890500122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ063701Medicare ID - Type UnspecifiedFACILITY