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General NPI Number Information
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NPI Number | 1790272425
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Entity Type | Organization
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Legal Business Name | TBD IV, PLLC
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Dates
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Enumeration Date | 04/18/2018
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Last Update Date | 04/18/2018
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Provider Practice Location Address
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Address Line | 750 E PUSCH VIEW LN STE 100
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City | ORO VALLEY
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State | AZ
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Zip | 85737-8766
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Country | US
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Telephone | 520-797-9524
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Fax |
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Provider Business Mailing Address
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Address Line | 10675 N SUMMER MOON PL
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City | TUCSON
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State | AZ
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Zip | 85737-8631
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Country | US
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Telephone | 502-640-3609
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Fax | 520-329-8848
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. THOMAS EDWARD BELL
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Credential | DMD
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Telephone | 502-640-3609
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D009150
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License Number State | AZ
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