Provider Demographics
NPI:1710036801
Name:BELL, THOMAS W JR (DDS)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:W
Last Name:BELL
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:200 DOCTORS DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-6308
Mailing Address - Country:US
Mailing Address - Phone:910-353-5171
Mailing Address - Fax:910-353-8810
Practice Address - Street 1:200 DOCTORS DR
Practice Address - Street 2:SUITE A
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-6308
Practice Address - Country:US
Practice Address - Phone:910-353-5171
Practice Address - Fax:910-353-8810
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC56941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8990604Medicaid
NC5906293Medicaid