Provider Demographics
NPI:1013954726
Name:JOHN R. WELLS, D.M.D., P. S. C.
Entity Type:Organization
Organization Name:JOHN R. WELLS, D.M.D., P. S. C.
Other - Org Name:HENDRICKS PEDIATRIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:317-852-8113
Mailing Address - Street 1:1411 S GREEN ST
Mailing Address - Street 2:SUITE #110
Mailing Address - City:BROWNSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46112-2049
Mailing Address - Country:US
Mailing Address - Phone:317-852-8113
Mailing Address - Fax:317-852-8115
Practice Address - Street 1:1411 S GREEN ST
Practice Address - Street 2:SUITE #110
Practice Address - City:BROWNSBURG
Practice Address - State:IN
Practice Address - Zip Code:46112-2049
Practice Address - Country:US
Practice Address - Phone:317-852-8113
Practice Address - Fax:317-852-8115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120099971223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty