Provider Demographics
NPI:1962616540
Name:ENG, WELLINGTON R (DDS)
Entity type:Individual
Prefix:DR
First Name:WELLINGTON
Middle Name:R
Last Name:ENG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1921 S. CATALINA AVE #2
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277
Mailing Address - Country:US
Mailing Address - Phone:310-378-7577
Mailing Address - Fax:310-378-6007
Practice Address - Street 1:1921 S. CATALINA AVE #2
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277
Practice Address - Country:US
Practice Address - Phone:310-378-7577
Practice Address - Fax:310-378-6007
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA404311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice