Provider Demographics
NPI:1841453347
Name:WELLMAN, MITCHELL C (DDS)
Entity type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:C
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 1:2001 W LINCOLN AVE
Mailing Address - Street 2:STE. 33
Mailing Address - City:FERGUS FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56537-1010
Mailing Address - Country:US
Mailing Address - Phone:218-739-2481
Mailing Address - Fax:218-739-2178
Practice Address - Street 1:2001 W LINCOLN AVE
Practice Address - Street 2:STE. 33
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537-1010
Practice Address - Country:US
Practice Address - Phone:218-739-2481
Practice Address - Fax:218-739-2178
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-03
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND126101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice