Provider Demographics
NPI:1972690824
Name:WELLS, SUSAN DENNIS (DMD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:DENNIS
Last Name:WELLS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 LOUISA ST
Mailing Address - Street 2:
Mailing Address - City:WARRIOR
Mailing Address - State:AL
Mailing Address - Zip Code:35180-1448
Mailing Address - Country:US
Mailing Address - Phone:205-647-2050
Mailing Address - Fax:205-647-6917
Practice Address - Street 1:309 LOUISA ST
Practice Address - Street 2:
Practice Address - City:WARRIOR
Practice Address - State:AL
Practice Address - Zip Code:35180-1448
Practice Address - Country:US
Practice Address - Phone:205-647-2050
Practice Address - Fax:205-647-6917
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2018-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3464124Q00000X, 126800000X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No124Q00000XDental ProvidersDental Hygienist
No126800000XDental ProvidersDental Assistant