Provider Demographics
NPI:1760547830
Name:WELLS, LYNDON S (DDS)
Entity Type:Individual
Prefix:DR
First Name:LYNDON
Middle Name:S
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 1:615 W HARWOOD RD
Mailing Address - Street 2:
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76054-3106
Mailing Address - Country:US
Mailing Address - Phone:817-268-2424
Mailing Address - Fax:817-268-2444
Practice Address - Street 1:615 W HARWOOD RD
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76054-3106
Practice Address - Country:US
Practice Address - Phone:817-268-2424
Practice Address - Fax:817-268-2444
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13233122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist