Provider Demographics
NPI:1366611477
Name:WELTON, DAVID GRAHAM (DDS)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:GRAHAM
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 1:611 NE MAIN ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LEWISTOWN
Mailing Address - State:MT
Mailing Address - Zip Code:59457-2020
Mailing Address - Country:US
Mailing Address - Phone:406-538-2347
Mailing Address - Fax:
Practice Address - Street 1:611 NE MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:LEWISTOWN
Practice Address - State:MT
Practice Address - Zip Code:59457-2020
Practice Address - Country:US
Practice Address - Phone:406-538-2347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-22
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT22861223G0001X
CA56319122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist