=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659417244
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | THOMAS JAMES BELL D.D.S.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/30/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 807 W HILLGROVE AVE
-----------------------------------------------------
City | LA GRANGE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60525-5822
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-352-8022
-----------------------------------------------------
Fax | 708-352-8074
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 807 W HILLGROVE AVE
-----------------------------------------------------
City | LA GRANGE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60525-5822
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-352-8022
-----------------------------------------------------
Fax | 708-352-8074
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 01916800
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------