Organization
WELLS ORAL & MAXILLOFACIAL SURGERY ASSOCIATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARVIN C WELLS D.M.D (PRESIDENT)
(904) 296-2226
Entity
Organization
Contact information
Practice address
4225 SOUTHPOINT PKWY S, JACKSONVILLE, FL 32216-0975
(904) 296-2226
(904) 296-8887
Mailing address
4225 SOUTHPOINT PKWY S, JACKSONVILLE, FL 32216-0975
(904) 296-2226
(904) 296-8887
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
8078
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0747998-00
—
FL
01
—
86833
BLUE CROSS & BLUE SHIELD
FL
Enumeration date
11/01/2012
Last updated
11/01/2012
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