MEDICARE: NICOLE WELLS DDS PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1366312811
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NICOLE WELLS DDS PLLC

Provider Business Mailing Address
First Line	:	298 N NC 16 BUSINESS HWY STE E
Second Line	:
City	:	DENVER
State	:	NC
Zip	:	28037-8480
Country	:	US
Telephone Number	:	704-483-1870
Fax Number	:	704-483-1221

Provider Business Practice Location Address
First Line	:	298 N NC 16 BUSINESS HWY STE E
Second Line	:
City	:	DENVER
State	:	NC
Zip	:	28037-8480
Country	:	US
Telephone Number	:	704-483-1870
Fax Number	:	704-483-1221

Authorized Official
Title or Position	:	PAYER ENROLLMENT MANAGER
Name	:	JENNY GARCIA-ROCHA
Credential	:
Telephone Number	:	972-869-3789

Provider Enumeration Date	:	11/10/2025
Last Update Date	:	11/10/2025

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