Provider Demographics
NPI:1750435566
Name:WELLMAN, JEFFREY G (DDS)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:G
Last Name:WELLMAN
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 1:14979 WEST BELL RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374
Mailing Address - Country:US
Mailing Address - Phone:623-476-5800
Mailing Address - Fax:623-476-5801
Practice Address - Street 1:14979 WEST BELL RD
Practice Address - Street 2:SUITE 150
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374
Practice Address - Country:US
Practice Address - Phone:623-476-5800
Practice Address - Fax:623-476-5801
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ56371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice