Provider Demographics
NPI:1154405249
Name:BELL, GARY STEPHEN (DDS MS)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:STEPHEN
Last Name:BELL
Suffix:
Gender:M
Credentials:DDS MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 548
Mailing Address - Street 2:805 W WARREN ST
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28150
Mailing Address - Country:US
Mailing Address - Phone:704-484-1633
Mailing Address - Fax:704-484-1633
Practice Address - Street 1:805 W WARREN ST
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150
Practice Address - Country:US
Practice Address - Phone:704-484-1633
Practice Address - Fax:704-484-1633
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC41681223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8990591Medicaid
U49108Medicare UPIN