Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 5464 | LA |
Y | 1223P0700X | Prosthodontist | LA 5464 | LA |
NPI | 1124004601 |
---|---|
Provider Name | Dr. David Lynn Bell JR. |
First Address | Millington, TN 38054-5028 |
Second Address | Portsmouth, VA 23708 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/12/2005 |
Last Update Date | 29/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000OTH | (02) |