Provider Demographics
NPI:1942045612
Name:BELL, KYLE
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:BELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 HARNETT ST APT 330
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-3168
Mailing Address - Country:US
Mailing Address - Phone:616-558-6011
Mailing Address - Fax:
Practice Address - Street 1:7205 WRIGHTSVILLE AVE STE 105
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-7273
Practice Address - Country:US
Practice Address - Phone:910-726-9888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-26
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC137311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice