Provider Demographics
NPI:1154417897
Name:WELLS, RICK DALE (DDS)
Entity type:Individual
Prefix:DR
First Name:RICK
Middle Name:DALE
Last Name:WELLS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:RICK
Other - Middle Name:DALE
Other - Last Name:WELLS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:20878 SAGE LN
Mailing Address - Street 2:
Mailing Address - City:TEHACHAPI
Mailing Address - State:CA
Mailing Address - Zip Code:93561-6423
Mailing Address - Country:US
Mailing Address - Phone:661-822-4861
Mailing Address - Fax:661-822-9212
Practice Address - Street 1:20878 SAGE LN
Practice Address - Street 2:
Practice Address - City:TEHACHAPI
Practice Address - State:CA
Practice Address - Zip Code:93561-6423
Practice Address - Country:US
Practice Address - Phone:661-822-4861
Practice Address - Fax:661-822-9212
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS 333151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice