Provider Demographics
NPI:1528002276
Name:WELLS, JOHN R (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:R
Last Name:WELLS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
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Mailing Address - Street 1:6378 TIMBER CLIMB
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123
Mailing Address - Country:US
Mailing Address - Phone:317-272-4799
Mailing Address - Fax:
Practice Address - Street 1:1411 S GREEN ST
Practice Address - Street 2:SUITE #110
Practice Address - City:BROWNSBURG
Practice Address - State:IN
Practice Address - Zip Code:46112-2049
Practice Address - Country:US
Practice Address - Phone:317-852-8113
Practice Address - Fax:317-852-8115
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120099971223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN102312OtherISDH/CSHCS
TN4081402OtherBCBS OF TN
210417OtherCIGNA PROVIDER NUMBER
AL630-23192OtherBCBS OF ALABAMA
863116OtherUNITED CONCORDIA