MEDICARE: DR. ELGIN EUGENE WELLS DDS

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	10016	TX

General Provider Information

NPI Number	:	1851425953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELGIN EUGENE WELLS DDS

Provider Business Mailing Address
First Line	:	3614 ABBEYWOOD DR
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77584-5900
Country	:	US
Telephone Number	:	281-412-3001
Fax Number	:

Provider Business Practice Location Address
First Line	:	2646 SOUTH LOOP W STE 440
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77054-5616
Country	:	US
Telephone Number	:	713-665-4455
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2007
Last Update Date	:	07/08/2007

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