Jack Randall Wells Jr., DDS
NPI 1396345963ActiveIndividual· Dentist· Albuquerque, NM
Dentist (DDS) in Albuquerque, New Mexico, licensed in NM, CO and NV, with an NPI issued in October 2020. Enrolled in Medicare as order and referring only - dentist.
Overview
| NPI | 1396345963 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Credential | DDS |
| Sole proprietor | Yes |
| NPI issued | Oct 31, 2020 |
| Last updated in NPPES | Oct 1, 2023 |
| Certified by provider | Oct 1, 2023 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Dentist Primary | 122300000X | DB-2023-0092 | NM |
| Dentist | 122300000X | DEN.00204532 | CO |
| Dentist, General Practice | 1223G0001X | 7425T | NV |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Order and Referring Only - Dentist (NV) |
|---|
Industry payments (Open Payments)
None reported for 2025 or 2024.
Receiving payments does not imply wrongdoing. What Open Payments covers ·original records
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