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General NPI Number Information
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NPI Number | 1104347236
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Entity Type | Individual
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Provider Name | JEFFERY A WELLS DDS
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Gender | Male
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Dates
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Enumeration Date | 06/28/2017
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Last Update Date | 06/28/2017
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Provider Practice Location Address
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Address Line | 1002 HARVEY RD NE
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City | AUBURN
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State | WA
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Zip | 98002-4220
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Country | US
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Telephone | 206-841-1657
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Fax |
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Provider Business Mailing Address
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Address Line | 346 NE 58TH ST
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City | SEATTLE
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State | WA
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Zip | 98105-2715
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Country | US
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Telephone | 206-841-1657
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DENT.DE.60772664
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License Number State | WA
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