Provider Demographics
NPI:1164610853
Name:WELLS, DENNIS J (DDS)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:J
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 1:105 POWELL CT
Mailing Address - Street 2:ST 101
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5085
Mailing Address - Country:US
Mailing Address - Phone:615-371-8878
Mailing Address - Fax:
Practice Address - Street 1:105 POWELL CT
Practice Address - Street 2:ST 101
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-5085
Practice Address - Country:US
Practice Address - Phone:615-371-8878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4738122300000X
CA51318122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist