Provider Demographics
NPI:1629233622
Name:DAVID L. WELLS II DMD MD PLLC
Entity Type:Organization
Organization Name:DAVID L. WELLS II DMD MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:II
Authorized Official - Credentials:MD DMD
Authorized Official - Phone:859-224-0065
Mailing Address - Street 1:3080 HARRODSBURG RD
Mailing Address - Street 2:SUITE 275
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-2774
Mailing Address - Country:US
Mailing Address - Phone:859-224-0065
Mailing Address - Fax:859-278-0903
Practice Address - Street 1:3080 HARRODSBURG RD
Practice Address - Street 2:SUITE 275
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-2774
Practice Address - Country:US
Practice Address - Phone:859-224-0065
Practice Address - Fax:859-278-0903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-19
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY37301261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery