Provider Demographics
NPI:1649651613
Name:WELLS, JENNIFER L (DMD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:L
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 1:2875 W RAY RD STE 16
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-3619
Mailing Address - Country:US
Mailing Address - Phone:480-792-1543
Mailing Address - Fax:
Practice Address - Street 1:2875 W RAY RD STE 16
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-3619
Practice Address - Country:US
Practice Address - Phone:480-792-1543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9248122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist