Provider Demographics
NPI:1386935476
Name:BELL, JACK ALEX III (DMD)
Entity type:Individual
Prefix:DR
First Name:JACK
Middle Name:ALEX
Last Name:BELL
Suffix:III
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 MARGIE DR
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-8933
Mailing Address - Country:US
Mailing Address - Phone:478-971-7707
Mailing Address - Fax:
Practice Address - Street 1:328 MARGIE DR
Practice Address - Street 2:SUITE A
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088
Practice Address - Country:US
Practice Address - Phone:478-971-7701
Practice Address - Fax:478-971-7705
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-25
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN014248122300000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program