Healthcare Provider Details

I. General information

NPI: 1699817239
Provider Name (Legal Business Name): AIRAN S. WELLS D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 LICK CREEK RD
ANNA IL
62906-3214
US

IV. Provider business mailing address

310 LICK CREEK RD
ANNA IL
62906-3214
US

V. Phone/Fax

Practice location:
  • Phone: 618-833-2411
  • Fax: 618-833-3045
Mailing address:
  • Phone: 618-833-2411
  • Fax: 618-833-3045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: