Provider Demographics
NPI:1427153642
Name:WELLS, ADAM BRENT (DMD)
Entity type:Individual
Prefix:DR
First Name:ADAM
Middle Name:BRENT
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 1:2634 ESCALA CIR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-6720
Mailing Address - Country:US
Mailing Address - Phone:502-548-7118
Mailing Address - Fax:502-852-7163
Practice Address - Street 1:2634 ESCALA CIR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-6720
Practice Address - Country:US
Practice Address - Phone:502-548-7118
Practice Address - Fax:502-852-7163
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY84181223G0001X
CA571231223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No1223G0001XDental ProvidersDentistGeneral Practice