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General NPI Number Information
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NPI Number | 1225813983
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Entity Type | Organization
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Legal Business Name | SHANE M. WELLINGTON DMD LLC
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Dates
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Enumeration Date | 08/30/2023
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Last Update Date | 08/30/2023
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Provider Practice Location Address
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Address Line | 1609 PENNSYLVANIA AVE
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City | EAST LIVERPOOL
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State | OH
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Zip | 43920-2146
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Country | US
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Telephone | 330-385-1352
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Fax | 330-385-7407
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Provider Business Mailing Address
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Address Line | 1609 PENNSYLVANIA AVE
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City | EAST LIVERPOOL
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State | OH
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Zip | 43920-2146
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Country | US
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Telephone | 330-385-1352
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Fax | 330-385-7407
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. SHANE MATTHEW WELLINGTON
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Credential | DMD
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Telephone | 330-385-1352
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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