Leslie Wells, D.M.D.
Individual provider Active NPI Dentist · New Augusta, MS
NPI 1053598433 · NPPES record last updated Oct 1, 2009
Key facts
- NPI
- 1053598433
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 3432-07 (MS)
- Practice address
- 203 Pine Street West
New Augusta, MS 39462-0411 - Phone
- (601) 964-8400
- Fax
- (601) 964-8404
- NPI assigned
- Jan 28, 2008
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160505000032 | MS | Order and Referring Only - Dentist |
5597064089 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3432-07 | MS | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Leslie Wells DMD, PLLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 3432-07 | MS | Yes |
Addresses
Primary practice location
203 Pine Street West
New Augusta, MS 39462-0411
Mailing address
PO Box 411
New Augusta, MS 39462-0411
Phone (601) 964-8400
Other providers in New Augusta, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 1, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.