Provider Demographics
NPI:1760891618
Name:WELLS, DAVID N (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:N
Last Name:WELLS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 673
Mailing Address - Street 2:803 EAST FOURTH STREET
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IN
Mailing Address - Zip Code:47620-0673
Mailing Address - Country:US
Mailing Address - Phone:812-838-4841
Mailing Address - Fax:812-838-4844
Practice Address - Street 1:803 EAST FOURTH STREET
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IN
Practice Address - Zip Code:47620-0673
Practice Address - Country:US
Practice Address - Phone:812-838-4841
Practice Address - Fax:812-838-4844
Is Sole Proprietor?:No
Enumeration Date:2014-08-05
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12012203A122300000X
IL019029853122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist