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General NPI Number Information
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NPI Number | 1588740468
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Entity Type | Organization
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Legal Business Name | JOE L. WELLS, JR., DDS PC
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Dates
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Enumeration Date | 10/31/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4324 COVINGTON HIGHWAY
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City | DECATUR
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State | GA
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Zip | 30035
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Country | US
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Telephone | 404-289-6454
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 736
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City | LITHONIA
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State | GA
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Zip | 30058
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Country | US
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Telephone | 404-289-6454
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOE L. WELLS JR.
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Credential | DDS
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Telephone | 404-289-6454
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 010527
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License Number State | GA
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