Provider Demographics
NPI:1528381753
Name:WELLS, DONNA GARRETT (DMD)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:GARRETT
Last Name:WELLS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7101 HOFF ST BLDG 9240
Mailing Address - Street 2:USA DENTAL ACTIVITY
Mailing Address - City:FORT BENNING
Mailing Address - State:GA
Mailing Address - Zip Code:31905-5645
Mailing Address - Country:US
Mailing Address - Phone:706-544-4530
Mailing Address - Fax:706-544-1933
Practice Address - Street 1:7101 HOFF ST BLDG 9240
Practice Address - Street 2:USA DENTAL ACTIVITY
Practice Address - City:FORT BENNING
Practice Address - State:GA
Practice Address - Zip Code:31905-5645
Practice Address - Country:US
Practice Address - Phone:706-544-4530
Practice Address - Fax:706-544-1933
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-02
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN011496122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist