=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023859519
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GRAYSON EVAN BELL D.D.S.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/06/2024
-----------------------------------------------------
Last Update Date | 06/06/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1371 COUNTRY CLUB RD
-----------------------------------------------------
City | GULF BREEZE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32563-3451
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-934-8222
-----------------------------------------------------
Fax | 850-934-8219
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1371 COUNTRY CLUB RD
-----------------------------------------------------
City | GULF BREEZE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32563-3451
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-934-8222
-----------------------------------------------------
Fax | 850-934-8219
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | DN28689
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------