MEDICARE: TBD III, PLLC

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1285104877
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TBD III, PLLC

Provider Business Mailing Address
First Line	:	1802 E PRINCE RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85719-1965
Country	:	US
Telephone Number	:	520-323-3186
Fax Number	:	520-323-5644

Provider Business Practice Location Address
First Line	:	1802 E PRINCE RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85719-1965
Country	:	US
Telephone Number	:	520-323-3186
Fax Number	:	520-323-5644

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. THOMAS BELL
Credential	:	DMD
Telephone Number	:	502-640-3609

Provider Enumeration Date	:	11/27/2018
Last Update Date	:	11/27/2018

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