Healthcare Provider Details

I. General information

NPI: 1891594032
Provider Name (Legal Business Name): L. BRETT WELLS DDS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2025
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1512 VILLAGE MARKET PL
MORRISVILLE NC
27560-7511
US

IV. Provider business mailing address

2920 FORESTVILLE RD # 100-06
RALEIGH NC
27616-8774
US

V. Phone/Fax

Practice location:
  • Phone: 919-266-5332
  • Fax:
Mailing address:
  • Phone: 919-266-5332
  • Fax: 919-229-8805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LAURA ILLINGWORTH
Title or Position: RCM
Credential:
Phone: 919-266-5332