Provider Demographics
NPI:1801869482
Name:WELLS, JENNIFER C (DMD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:C
Last Name:WELLS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1010 PRINCE AVE
Mailing Address - Street 2:STE. 202 E
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-5811
Mailing Address - Country:US
Mailing Address - Phone:706-548-7373
Mailing Address - Fax:706-548-8088
Practice Address - Street 1:1010 PRINCE AVE
Practice Address - Street 2:STE. 202 E
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-5811
Practice Address - Country:US
Practice Address - Phone:706-548-7373
Practice Address - Fax:706-548-8088
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-13
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA0115771223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00889798BMedicaid