Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | DS020540L | PA |
NPI | 1073532164 |
---|---|
Provider Name | Donald W Wells |
First Address | State College, PA 16801-7966 |
Second Address | State College, PA 16801-7966 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
112944 | UNITED CONCORDIA (01) | PA |