Provider Demographics
NPI:1801098462
Name:WELLS, FRANK SIMMONS (DDS)
Entity type:Individual
Prefix:DR
First Name:FRANK
Middle Name:SIMMONS
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 1:717 CROWS NEST CT
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28409-3935
Mailing Address - Country:US
Mailing Address - Phone:910-799-1913
Mailing Address - Fax:
Practice Address - Street 1:717 CROWS NEST CT
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28409-3935
Practice Address - Country:US
Practice Address - Phone:910-799-1913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC42711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8999113Medicaid
NCU35863Medicare UPIN