=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750250460
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | L. BRETT WELLS DDS X PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/31/2025
-----------------------------------------------------
Last Update Date | 10/31/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 65 RAMSEUR RD STE 120
-----------------------------------------------------
City | PITTSBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27312
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-266-5332
-----------------------------------------------------
Fax | 919-229-8805
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2920 FORESTVILLE RD STE 100-06
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27616-8774
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-266-5332
-----------------------------------------------------
Fax | 919-229-8805
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | RCM MANAGER
-----------------------------------------------------
Name | LAURA ILLINGWORTH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 919-266-5332
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------