Provider Demographics
NPI:1902816168
Name:WELLS, PHILIP JULIUS (DDS)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:JULIUS
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 1:3702 CLEVELAND AVE SW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44707-1450
Mailing Address - Country:US
Mailing Address - Phone:330-484-6401
Mailing Address - Fax:330-484-3808
Practice Address - Street 1:3702 CLEVELAND AVE SW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44707-1450
Practice Address - Country:US
Practice Address - Phone:330-484-6401
Practice Address - Fax:330-484-3808
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH16267122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist