Individual
DR. JACK RANDALL WELLS JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
9201 EAGLE RANCH RD NW, ALBUQUERQUE, NM 87114-6440
(505) 892-9010
Mailing address
1851 STEAMBOAT PKWY UNIT 4801, RENO, NV 89521-6337
(505) 363-8031
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DB-2023-0092
NM
122300000X
Dentist
DEN.00204532
CO
1223G0001X
General Practice Dentistry
7425T
NV
Other
Enumeration date
10/31/2020
Last updated
10/01/2023
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