Individual
MRS. MIKIALA CHAE WELLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH, BSDH
Contact information
Practice address
1647 E STONE DR, KINGSPORT, TN 37660-4609
(423) 245-2202
Mailing address
1006 CATAWBA ST, KINGSPORT, TN 37660-4502
(276) 870-1378
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
7324
TN
Other
Enumeration date
10/21/2019
Last updated
10/21/2019
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