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General NPI Number Information
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NPI Number | 1407745599
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Entity Type | Organization
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Legal Business Name | PHILLIP T WELLER DDS PLLC
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Dates
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Enumeration Date | 07/02/2025
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Last Update Date | 07/17/2025
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Provider Practice Location Address
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Address Line | 3305 16TH AVE SE STE 301
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City | CONOVER
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State | NC
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Zip | 28613
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Country | US
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Telephone | 435-659-4336
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Fax |
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Provider Business Mailing Address
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Address Line | 3305 16TH AVE SE STE 301
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City | CONOVER
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State | NC
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Zip | 28613-9213
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Country | US
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Telephone | 828-465-0187
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Fax |
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Authorized Official
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Title or Position | PERIODONTIST
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Name | DR. PHILLIP TATE WELLER
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Credential | DDS
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Telephone | 435-659-4336
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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