Provider Demographics
NPI:1942043245
Name:BELL, BLAKE STEWART (DMD)
Entity type:Individual
Prefix:DR
First Name:BLAKE
Middle Name:STEWART
Last Name:BELL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1855 LAKELAND DR APT 226
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-0003
Mailing Address - Country:US
Mailing Address - Phone:601-421-4803
Mailing Address - Fax:
Practice Address - Street 1:7731 OLD CANTON RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-6114
Practice Address - Country:US
Practice Address - Phone:601-790-0121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-14
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS4455-241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice