MEDICARE: DR. SEAN PHILIP WELANDER D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	D13796	MN

General Provider Information

NPI Number	:	1033477492
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SEAN PHILIP WELANDER D.D.S.

Provider Business Mailing Address
First Line	:	3950 VETERANS DR STE 100
Second Line	:
City	:	SAINT CLOUD
State	:	MN
Zip	:	56303-3424
Country	:	US
Telephone Number	:	320-252-3611
Fax Number	:	320-252-7574

Provider Business Practice Location Address
First Line	:	3950 VETERANS DR STE 100
Second Line	:
City	:	SAINT CLOUD
State	:	MN
Zip	:	56303-3424
Country	:	US
Telephone Number	:	320-252-3611
Fax Number	:	320-252-7574

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/23/2012
Last Update Date	:	07/21/2022

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Directions to “ DR. SEAN PHILIP WELANDER D.D.S.” Practice Location

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