Healthcare Provider Details

I. General information

NPI: 1760046635
Provider Name (Legal Business Name): ANDREW WELLING DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2019
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 W PAGES LN # 100
BOUNTIFUL UT
84010-5988
US

IV. Provider business mailing address

59 W PAGES LN # 100
BOUNTIFUL UT
84010-5988
US

V. Phone/Fax

Practice location:
  • Phone: 801-292-1222
  • Fax:
Mailing address:
  • Phone: 801-292-1222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number12198318-9926
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: