MEDICARE: DR. NICOLE RENEE WELLS DDS

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	122300000X	Dentist	8953	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8958	OTHER	NC	DENTAL LICENSE NUMBER

General Provider Information

NPI Number	:	1639499155
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICOLE RENEE WELLS DDS

Provider Business Mailing Address
First Line	:	298 N HWY 16
Second Line	:	STE E
City	:	DENVER
State	:	NC
Zip	:	28037-8480
Country	:	US
Telephone Number	:	704-483-1870
Fax Number	:	704-483-1221

Provider Business Practice Location Address
First Line	:	298 N HWY 16
Second Line	:	STE E
City	:	DENVER
State	:	NC
Zip	:	28037-8480
Country	:	US
Telephone Number	:	704-483-1870
Fax Number	:	704-483-1221

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

Provider Enumeration Date	:	06/07/2010
Last Update Date	:	01/13/2026

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