Provider Demographics
NPI:1376642041
Name:WELLS, WAVEL LOU (DDS)
Entity Type:Individual
Prefix:DR
First Name:WAVEL
Middle Name:LOU
Last Name:WELLS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4417 W GORE BLVD
Mailing Address - Street 2:SUITE 11
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-5978
Mailing Address - Country:US
Mailing Address - Phone:580-248-8418
Mailing Address - Fax:580-248-4118
Practice Address - Street 1:4417 W GORE BLVD STE 11
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-5978
Practice Address - Country:US
Practice Address - Phone:580-248-8418
Practice Address - Fax:580-248-4118
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK34941223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100194430AMedicaid