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NPI Code Detail

MEDICARE: DR. KEVEN D WELLS D.D.S.

MEDICARE: DR. KEVEN D WELLS D.D.S.
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
11223G0001XGeneral Practice Dentistry019026710IL

General Provider Information

NPI Number : 1841415213
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KEVEN D WELLS D.D.S.
Provider Business Mailing Address
First Line : 1516 LEGACY CIR STE 104
Second Line :
City : NAPERVILLE
State : IL
Zip : 60563-1253
Country : US
Telephone Number : 630-505-1516
Fax Number : 630-505-1601
Provider Business Practice Location Address
First Line : 1516 LEGACY CIR STE 104
Second Line :
City : NAPERVILLE
State : IL
Zip : 60563-1253
Country : US
Telephone Number : 630-505-1516
Fax Number : 630-505-1601
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/13/2007
Last Update Date : 09/22/2020

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