Individual provider Active NPI

Robert Henry Wells Jr., D.D.S.

  • General Practice Dentistry
  • Sallisaw, OK
National Provider Identifier
1053429613
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
4740 Issued in OK
Practice address
200 E Choctaw Ave
Sallisaw, OK 74955-4604
Phone
(918) 775-3201
Fax
(918) 775-3394
NPI assigned
Aug 25, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 4740 OK Primary

Addresses

Primary practice location

200 E Choctaw Ave
Sallisaw, OK 74955-4604

Mailing address

200 E Choctaw Ave
PO Box 625
Sallisaw, OK 74955-4604
Phone (918) 775-3201

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160627001989 OK Order and Referring Only - DentistPractitioner - Dentist 9234420951

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Bwdentistry General Practice Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156464000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1053429613",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 E CHOCTAW AVE",
            "address_2": "PO BOX 625",
            "city": "SALLISAW",
            "state": "OK",
            "postal_code": "749554604",
            "telephone_number": "918-775-3201",
            "fax_number": "918-775-3394"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 E CHOCTAW AVE",
            "city": "SALLISAW",
            "state": "OK",
            "postal_code": "749554604",
            "telephone_number": "918-775-3201",
            "fax_number": "918-775-3394"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WELLS",
        "first_name": "ROBERT",
        "middle_name": "HENRY",
        "name_suffix": "Jr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-25",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OK",
            "license": "4740",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sallisaw, OK

Sources for this page

Verify at the official NPI Registry.