Provider Demographics
NPI:1851425953
Name:WELLS, ELGIN EUGENE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELGIN
Middle Name:EUGENE
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 1:3614 ABBEYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-5900
Mailing Address - Country:US
Mailing Address - Phone:281-412-3001
Mailing Address - Fax:
Practice Address - Street 1:2646 SOUTH LOOP W STE 440
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-5616
Practice Address - Country:US
Practice Address - Phone:713-665-4455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100161223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics