Healthcare Provider Details

I. General information

NPI: 1962716449
Provider Name (Legal Business Name): DAWN K WELDON D.D.S., M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2010
Last Update Date: 07/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

423 EAST 23RD STREET
NEW YORK CITY NY
10010
US

IV. Provider business mailing address

424 W 147TH ST APT 3
NEW YORK NY
10031-4806
US

V. Phone/Fax

Practice location:
  • Phone: 212-686-7500
  • Fax: 212-951-3378
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number055979-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number010966
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: