Organization
LESLIE WELLS DMD, PLLC
Active
Other names
New Augusta Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LESLIE RAE WELLS DMD (OWNER)
(601) 964-8400
Entity
Organization
Contact information
Practice address
203 PINE STREET WEST, NEW AUGUSTA, MS 39462-0411
(601) 964-8400
(601) 964-8400
Mailing address
PO BOX 411, NEW AUGUSTA, MS 39462-0411
(601) 964-8400
(601) 964-8404
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
343207
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05838340
—
MS
Enumeration date
01/22/2010
Last updated
01/22/2010
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