Provider Demographics
NPI:1073532164
Name:WELLS, DONALD W (DDS)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:W
Last Name:WELLS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 REGENT CT
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-7966
Mailing Address - Country:US
Mailing Address - Phone:814-234-2428
Mailing Address - Fax:814-231-0110
Practice Address - Street 1:110 REGENT CT
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-7966
Practice Address - Country:US
Practice Address - Phone:814-234-2428
Practice Address - Fax:814-231-0110
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS020540L1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA112944OtherUNITED CONCORDIA