Provider Demographics
NPI:1033602925
Name:WELLS, COREY J (DMD)
Entity Type:Individual
Prefix:DR
First Name:COREY
Middle Name:J
Last Name:WELLS
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:PO BOX 7
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:NH
Mailing Address - Zip Code:03584-0007
Mailing Address - Country:US
Mailing Address - Phone:603-788-2517
Mailing Address - Fax:603-788-2520
Practice Address - Street 1:22 BUNKER HILL ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:NH
Practice Address - Zip Code:03584-3009
Practice Address - Country:US
Practice Address - Phone:603-788-2517
Practice Address - Fax:603-788-2520
Is Sole Proprietor?:No
Enumeration Date:2018-06-14
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH4417122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist