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General NPI Number Information
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NPI Number | 1518491877
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Entity Type | Organization
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Legal Business Name | WELLS DENTISTRY PC
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Dates
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Enumeration Date | 04/13/2017
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Last Update Date | 04/13/2017
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Provider Practice Location Address
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Address Line | 1933 EAST A STREET
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City | CASPER
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State | WY
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Zip | 82601-2224
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Country | US
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Telephone | 307-237-8435
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Fax | 307-237-2841
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Provider Business Mailing Address
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Address Line | 1933 EAST A STREET
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City | CASPER
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State | WY
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Zip | 82601-2224
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Country | US
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Telephone | 307-237-8435
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Fax | 307-237-2841
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Authorized Official
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Title or Position | OWNER
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Name | DR. JESSICA NICOLE WELLS
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Credential | D.D.S.
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Telephone | 307-237-8435
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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 | 1449
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License Number State | WY
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