Basic Information
| Provider Information | |||||||||
| NPI: | 1538714639 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WELLS | ||||||||
| FirstName: | DIONNE | ||||||||
| MiddleName: | JOI | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1607 DEFOORS WALK NW | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303183003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6786565349 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3805 DALLAS HWY SW STE 806 | ||||||||
| Address2: | |||||||||
| City: | MARIETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300641620 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6782033464 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/06/2019 | ||||||||
| LastUpdateDate: | 08/06/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | DN015942 | GA | Y | Dental Providers | Dentist |
No ID Information.