MEDICARE: DR. ADAM BRENT WELLS DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	8418	KY
2	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	57123	CA

General Provider Information

NPI Number	:	1427153642
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ADAM BRENT WELLS DMD

Provider Business Mailing Address
First Line	:	2634 ESCALA CIR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-6720
Country	:	US
Telephone Number	:	502-548-7118
Fax Number	:	502-852-7163

Provider Business Practice Location Address
First Line	:	2634 ESCALA CIR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-6720
Country	:	US
Telephone Number	:	502-548-7118
Fax Number	:	502-852-7163

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2006
Last Update Date	:	07/11/2008

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