Individual
RANDY R WELLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
829 PLAZA DR, MARTINSVILLE, IN 46151-3236
(765) 342-7090
(765) 342-6703
Mailing address
829 PLAZA DR, MARTINSVILLE, IN 46151-3236
(765) 342-7090
(765) 342-6703
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12008048A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000381013
BLUE CROSS PIN#
IN
05
—
WE561870
—
IN
Enumeration date
10/03/2006
Last updated
07/08/2007
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