Provider Demographics
NPI:1316386576
Name:JENNIFER L WELLS DDS PA
Entity Type:Organization
Organization Name:JENNIFER L WELLS DDS PA
Other - Org Name:FIRST IMPRESSIONS FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:704-933-2115
Mailing Address - Street 1:814 SLOOP AVE
Mailing Address - Street 2:
Mailing Address - City:KANNAPOLIS
Mailing Address - State:NC
Mailing Address - Zip Code:28083-2992
Mailing Address - Country:US
Mailing Address - Phone:704-933-2115
Mailing Address - Fax:704-932-2053
Practice Address - Street 1:814 SLOOP AVE
Practice Address - Street 2:
Practice Address - City:KANNAPOLIS
Practice Address - State:NC
Practice Address - Zip Code:28083-2992
Practice Address - Country:US
Practice Address - Phone:704-933-2115
Practice Address - Fax:704-932-2053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-21
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC95381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty