Provider Demographics
NPI:1184763468
Name:WELLS, RICHARD GRANT II (DDS, MA)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:GRANT
Last Name:WELLS
Suffix:II
Gender:M
Credentials:DDS, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1056 KINGS ROW ST
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:CO
Mailing Address - Zip Code:81623-9691
Mailing Address - Country:US
Mailing Address - Phone:970-963-2747
Mailing Address - Fax:970-963-2747
Practice Address - Street 1:289 MAIN ST
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:CO
Practice Address - Zip Code:81623-2138
Practice Address - Country:US
Practice Address - Phone:970-963-3010
Practice Address - Fax:970-963-4104
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO84821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice