Provider Demographics
NPI:1518699438
Name:WELLS, BRANDON HART (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:HART
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 1:515 SUMMER DR
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30328-6023
Mailing Address - Country:US
Mailing Address - Phone:434-917-9909
Mailing Address - Fax:
Practice Address - Street 1:1205 FRIENDSHIP RD
Practice Address - Street 2:
Practice Address - City:BRASELTON
Practice Address - State:GA
Practice Address - Zip Code:30517-5608
Practice Address - Country:US
Practice Address - Phone:470-778-5120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-29
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN1227381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice