Provider Demographics
NPI:1750399424
Name:WELLS, J ROBERT (DDS)
Entity type:Individual
Prefix:
First Name:J
Middle Name:ROBERT
Last Name:WELLS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 S MARSHALL ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:TX
Mailing Address - Zip Code:75654-3980
Mailing Address - Country:US
Mailing Address - Phone:903-657-9551
Mailing Address - Fax:903-657-4247
Practice Address - Street 1:505 S MARSHALL ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:TX
Practice Address - Zip Code:75654-3980
Practice Address - Country:US
Practice Address - Phone:903-657-9551
Practice Address - Fax:903-657-4247
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice