Provider Demographics
NPI:1619195328
Name:WELLS, MELVIN THOMAS JR (DDS)
Entity Type:Individual
Prefix:
First Name:MELVIN
Middle Name:THOMAS
Last Name:WELLS
Suffix:JR
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 1:401 GREGORY LN STE 218
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-2846
Mailing Address - Country:US
Mailing Address - Phone:925-685-1050
Mailing Address - Fax:925-685-1080
Practice Address - Street 1:401 GREGORY LN STE 218
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-2846
Practice Address - Country:US
Practice Address - Phone:925-685-1050
Practice Address - Fax:925-685-1080
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27572122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist