Healthcare Provider Details

I. General information

NPI: 1407745599
Provider Name (Legal Business Name): PHILLIP T WELLER DDS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2025
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3305 16TH AVE SE STE 301
CONOVER NC
28613
US

IV. Provider business mailing address

3305 16TH AVE SE STE 301
CONOVER NC
28613-9213
US

V. Phone/Fax

Practice location:
  • Phone: 435-659-4336
  • Fax:
Mailing address:
  • Phone: 828-465-0187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. PHILLIP TATE WELLER
Title or Position: PERIODONTIST
Credential: DDS
Phone: 435-659-4336