Provider Demographics
NPI:1124199583
Name:WELLS, DWIGHT STEPHEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:DWIGHT
Middle Name:STEPHEN
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 1:720 BRYAN DR
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74701-7032
Mailing Address - Country:US
Mailing Address - Phone:580-924-2063
Mailing Address - Fax:
Practice Address - Street 1:720 BRYAN DR
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-7032
Practice Address - Country:US
Practice Address - Phone:580-924-2063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK42781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice