MEDICARE: DR. LAUREN ASHLEY WELLS

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	62770	CA
2	122300000X	Dentist	134667	AK

General Provider Information

NPI Number	:	1710319298
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAUREN ASHLEY WELLS

Provider Business Mailing Address
First Line	:	4745 S 3200 W
Second Line	:
City	:	TAYLORSVILLE
State	:	UT
Zip	:	84129-2822
Country	:	US
Telephone Number	:	801-964-6214
Fax Number	:	801-982-9232

Provider Business Practice Location Address
First Line	:	7985 E 16TH AVE # 300
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99504-2896
Country	:	US
Telephone Number	:	907-333-5522
Fax Number	:

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

Provider Enumeration Date	:	08/06/2013
Last Update Date	:	02/06/2023

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