Healthcare Provider Details

I. General information

NPI: 1972690824
Provider Name (Legal Business Name): SUSAN DENNIS WELLS DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 02/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 LOUISA ST
WARRIOR AL
35180-1448
US

IV. Provider business mailing address

309 LOUISA ST
WARRIOR AL
35180-1448
US

V. Phone/Fax

Practice location:
  • Phone: 205-647-2050
  • Fax: 205-647-6917
Mailing address:
  • Phone: 205-647-2050
  • Fax: 205-647-6917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number3464
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number3464
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number3464
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: