Provider Demographics
NPI:1851349971
Name:WELLS, GORDAN W (DDS)
Entity Type:Individual
Prefix:
First Name:GORDAN
Middle Name:W
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 1:702 W DRAKE RD
Mailing Address - Street 2:BLDG G SUITE 107
Mailing Address - City:FT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526
Mailing Address - Country:US
Mailing Address - Phone:970-493-9299
Mailing Address - Fax:970-530-2488
Practice Address - Street 1:702 W DRAKE RD
Practice Address - Street 2:BLDG G SUITE 107
Practice Address - City:FT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526
Practice Address - Country:US
Practice Address - Phone:970-493-9299
Practice Address - Fax:970-530-2488
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO104511122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist