Healthcare Provider Details

I. General information

NPI: 1124989421
Provider Name (Legal Business Name): WELLS DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2025
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6246 E PIMA ST STE 140
TUCSON AZ
85712-3165
US

IV. Provider business mailing address

6246 E PIMA ST STE 140
TUCSON AZ
85712-3165
US

V. Phone/Fax

Practice location:
  • Phone: 480-694-6346
  • Fax:
Mailing address:
  • Phone: 480-694-6346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: JAMAL WELLS
Title or Position: CEO
Credential: DDS
Phone: 928-202-0181