Jeremy Mantle Wells, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

12590570-9926 Issued in UT

Practice address

2630 Central Ave
Eielson AFB, AK 99702-2301

Phone

(907) 377-6767

NPI assigned

Aug 2, 2016

Last updated

Jul 29, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1470096000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722211200000",
    "number": "1114470580",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1615 TRUEMPER ST",
            "city": "JBSA LACKLAND",
            "state": "TX",
            "postal_code": "782365511",
            "telephone_number": "210-292-0123"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2630 CENTRAL AVE",
            "city": "EIELSON AFB",
            "state": "AK",
            "postal_code": "997022301",
            "telephone_number": "907-377-6767"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WELLS",
        "first_name": "JEREMY",
        "middle_name": "MANTLE",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-08-02",
        "last_updated": "2024-07-29",
        "certification_date": "2024-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "UT",
            "license": "12590570-9926",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Drayden Turman, MED, ATC
• Thomas Michael Urbany, IDMT
• Anthony-Edward K Urbi, ATC
• Amy Elizabeth Vagedes
• Genesis Y Velasquez
• Brandy Willett, PHARMD
• Katherine Patterson Willett, PA-C
• Ulyana Aleksandrovna Zagurskaya, DO
• Mackenzie May Zora, OD

• Dentist in Eielson AFB, AK
• Providers in Eielson AFB, AK by specialty
• Dentist in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.