Healthcare Provider Details

I. General information

NPI: 1710319298
Provider Name (Legal Business Name): DR. LAUREN ASHLEY WELLS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2013
Last Update Date: 02/06/2023
Certification Date: 02/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7985 E 16TH AVE # 300
ANCHORAGE AK
99504-2896
US

IV. Provider business mailing address

4745 S 3200 W
TAYLORSVILLE UT
84129-2822
US

V. Phone/Fax

Practice location:
  • Phone: 907-333-5522
  • Fax:
Mailing address:
  • Phone: 801-964-6214
  • Fax: 801-982-9232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number134667
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number62770
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: