Healthcare Provider Details

I. General information

NPI: 1851726749
Provider Name (Legal Business Name): WELLS DENTAL GROUP INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2013
Last Update Date: 09/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20878 SAGE LN
TEHACHAPI CA
93561-6423
US

IV. Provider business mailing address

20878 SAGE LN
TEHACHAPI CA
93561-6423
US

V. Phone/Fax

Practice location:
  • Phone: 661-822-4861
  • Fax: 661-822-9212
Mailing address:
  • Phone: 661-822-4861
  • Fax: 661-822-9212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number033315
License Number StateCA

VIII. Authorized Official

Name: DR. RICK DALE WELLS
Title or Position: OWNER
Credential: DDS
Phone: 661-822-4861