Provider Demographics
NPI:1073561627
Name:WELTON, MICHAEL PETER (DDS)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:PETER
Last Name:WELTON
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 1:3000 ALAMO DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-6350
Mailing Address - Country:US
Mailing Address - Phone:707-452-0420
Mailing Address - Fax:707-452-0683
Practice Address - Street 1:3000 ALAMO DR
Practice Address - Street 2:SUITE 103
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-6350
Practice Address - Country:US
Practice Address - Phone:707-452-0420
Practice Address - Fax:707-452-0683
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37035122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist