Provider Demographics
NPI:1891189759
Name:WELLES, ANDREW D (DDS)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:D
Last Name:WELLES
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 1:8055 MEADOW ROCK DR
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:WI
Mailing Address - Zip Code:54476-5233
Mailing Address - Country:US
Mailing Address - Phone:715-574-2477
Mailing Address - Fax:
Practice Address - Street 1:8055 MEADOW ROCK DR
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:WI
Practice Address - Zip Code:54476-5233
Practice Address - Country:US
Practice Address - Phone:715-241-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-27
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1001099-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1891189759Medicaid