Provider Demographics
NPI:1205951167
Name:WELLS, DAVID (DDS)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
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 1:25 FOOTHILLS PKWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MARBLE HILL
Mailing Address - State:GA
Mailing Address - Zip Code:30148-2261
Mailing Address - Country:US
Mailing Address - Phone:770-893-2340
Mailing Address - Fax:770-893-2342
Practice Address - Street 1:25 FOOTHILLS PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:MARBLE HILL
Practice Address - State:GA
Practice Address - Zip Code:30148-2261
Practice Address - Country:US
Practice Address - Phone:770-893-2340
Practice Address - Fax:770-893-2342
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN15639721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice