Provider Demographics
NPI:1417139650
Name:WELLS, WENDY L (DMD)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:L
Last Name:WELLS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1840 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:IL
Mailing Address - Zip Code:61081-1202
Mailing Address - Country:US
Mailing Address - Phone:815-625-2532
Mailing Address - Fax:815-625-2561
Practice Address - Street 1:1840 1ST AVE
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:IL
Practice Address - Zip Code:61081-1202
Practice Address - Country:US
Practice Address - Phone:815-625-2532
Practice Address - Fax:815-625-2561
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice