Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 14266 | TX |
NPI | 1013933522 |
---|---|
Provider Name | Dr. David Lynn Wells |
First Address | Jbsa Lackland, TX 78236-9908 |
Second Address | Jbsa Lackland, TX 78236-9908 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2006 |
Last Update Date | 04/08/2019 |