MEDICARE: ALBANY FAMILY DENTISTRY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	D4685	OR

General Provider Information

NPI Number	:	1083092506
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALBANY FAMILY DENTISTRY

Provider Business Mailing Address
First Line	:	1819 14TH AVE SE
Second Line	:
City	:	ALBANY
State	:	OR
Zip	:	97322-8502
Country	:	US
Telephone Number	:	541-791-8000
Fax Number	:	541-928-6960

Provider Business Practice Location Address
First Line	:	1819 14TH AVE SE
Second Line	:
City	:	ALBANY
State	:	OR
Zip	:	97322-8502
Country	:	US
Telephone Number	:	541-791-8000
Fax Number	:	541-928-6960

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. THOMAS M BELL
Credential	:	D.D.S.
Telephone Number	:	541-791-8000

Provider Enumeration Date	:	05/16/2015
Last Update Date	:	05/16/2015

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Directions to “ALBANY FAMILY DENTISTRY ” Practice Location

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