Provider Demographics
NPI:1538170386
Name:WELLS, JASON D (DDS)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:D
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 1:700 S FRONT ST
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-4919
Mailing Address - Country:US
Mailing Address - Phone:785-825-6211
Mailing Address - Fax:785-825-8787
Practice Address - Street 1:700 S FRONT ST
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-4919
Practice Address - Country:US
Practice Address - Phone:785-825-6211
Practice Address - Fax:785-825-8787
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS60395122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS60395OtherKS LICENCE NUMBER