Provider Demographics
NPI:1386774115
Name:WELLS, ERIK HUNT (DMD)
Entity type:Individual
Prefix:DR
First Name:ERIK
Middle Name:HUNT
Last Name:WELLS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 PRINCE AVE
Mailing Address - Street 2:SUITE 202 EAST
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-5805
Mailing Address - Country:US
Mailing Address - Phone:706-548-7373
Mailing Address - Fax:706-548-8088
Practice Address - Street 1:1010 PRINCE AVE
Practice Address - Street 2:SUITE 202 EAST
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-5805
Practice Address - Country:US
Practice Address - Phone:706-548-7373
Practice Address - Fax:706-548-8088
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0113641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA9180960OtherDORAL
GA000912667BMedicaid