Healthcare Provider Details

I. General information

NPI: 1528002276
Provider Name (Legal Business Name): JOHN R. WELLS D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 S GREEN ST SUITE #110
BROWNSBURG IN
46112-2049
US

IV. Provider business mailing address

6378 TIMBER CLIMB
AVON IN
46123
US

V. Phone/Fax

Practice location:
  • Phone: 317-852-8113
  • Fax: 317-852-8115
Mailing address:
  • Phone: 317-272-4799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number12009997
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: