Provider Demographics
NPI:1447421995
Name:WELLS, CHRISTOPHER R (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:R
Last Name:WELLS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1880 JUDITH LN STE 210
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-3185
Mailing Address - Country:US
Mailing Address - Phone:208-345-2771
Mailing Address - Fax:208-345-2888
Practice Address - Street 1:1880 JUDITH LN STE 210
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-3185
Practice Address - Country:US
Practice Address - Phone:208-345-2771
Practice Address - Fax:208-345-2888
Is Sole Proprietor?:No
Enumeration Date:2008-03-12
Last Update Date:2008-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-35681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice