Provider Demographics
NPI:1952500290
Name:WELLS, LOREN B (DDS)
Entity Type:Individual
Prefix:DR
First Name:LOREN
Middle Name:B
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 1:8450 LOUISBURG RD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-8006
Mailing Address - Country:US
Mailing Address - Phone:919-360-0097
Mailing Address - Fax:919-435-7371
Practice Address - Street 1:8450 LOUISBURG RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27616-7515
Practice Address - Country:US
Practice Address - Phone:919-266-5332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC81591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice