Provider Demographics
NPI:1104027713
Name:WELLS, STEVEN E (DMD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:E
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 1:1612 MOUNT VERNON FOREST CT
Mailing Address - Street 2:
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30338-4607
Mailing Address - Country:US
Mailing Address - Phone:770-868-8788
Mailing Address - Fax:770-868-8781
Practice Address - Street 1:48 PIEDMONT DR
Practice Address - Street 2:SUITE 302
Practice Address - City:WINDER
Practice Address - State:GA
Practice Address - Zip Code:30680-8131
Practice Address - Country:US
Practice Address - Phone:770-868-8788
Practice Address - Fax:770-868-8781
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0135281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice