Healthcare Provider Details

I. General information

NPI: 1871611988
Provider Name (Legal Business Name): WELDON MAX RENO D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 EUCLID STREET BOX 1209
PANHANDLE TX
79068-1209
US

IV. Provider business mailing address

312 EUCLID BOX 1209
PANHANDLE TX
79068-1209
US

V. Phone/Fax

Practice location:
  • Phone: 806-537-5176
  • Fax:
Mailing address:
  • Phone: 806-537-5176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7863
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: