1942359997 NPI number — THOMAS W. BELL, JR., DDS AND EDWARD G. COVERT, DDS, DME

Table of content: (NPI 1023041233)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942359997 NPI number — THOMAS W. BELL, JR., DDS AND EDWARD G. COVERT, DDS, DME

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THOMAS W. BELL, JR., DDS AND EDWARD G. COVERT, DDS, DME
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
FAMILY COMPREHENSIVE & COSMETIC DENTISTRY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1942359997
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/06/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 DOLPHIN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28546-5291
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-353-5171
Provider Business Mailing Address Fax Number:
910-353-8810

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 DOLPHIN DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28546
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-353-5171
Provider Business Practice Location Address Fax Number:
910-353-8810
Provider Enumeration Date:
01/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ORR
Authorized Official First Name:
SUSIE
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
910-353-5171

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  5694 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1223G0001X , with the licence number: 6662 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5905672 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8990604 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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