Provider Demographics
NPI:1043220114
Name:WELLS, ALLEN COWPER (DDS)
Entity type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:COWPER
Last Name:WELLS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 850
Mailing Address - Street 2:
Mailing Address - City:SAPULPA
Mailing Address - State:OK
Mailing Address - Zip Code:74067-0850
Mailing Address - Country:US
Mailing Address - Phone:918-224-1811
Mailing Address - Fax:918-224-1811
Practice Address - Street 1:415 S MISSION ST
Practice Address - Street 2:
Practice Address - City:SAPULPA
Practice Address - State:OK
Practice Address - Zip Code:74066-4653
Practice Address - Country:US
Practice Address - Phone:918-224-1811
Practice Address - Fax:918-224-1811
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4276122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist