Provider Demographics
NPI:1861580714
Name:WELLS, RICHARD W (DDS)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:W
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 1:1049 NORTH DEMAREE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-4119
Mailing Address - Country:US
Mailing Address - Phone:559-625-5200
Mailing Address - Fax:559-625-3037
Practice Address - Street 1:1049 NORTH DEMAREE
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-4119
Practice Address - Country:US
Practice Address - Phone:559-625-5200
Practice Address - Fax:559-625-3037
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA248961223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics