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General NPI Number Information
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NPI Number | 1548666241
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Entity Type | Organization
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Legal Business Name | WELLDENT I PA
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Dates
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Enumeration Date | 11/07/2014
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Last Update Date | 11/07/2014
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Provider Practice Location Address
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Address Line | 2550 S IH 35 SUITE 215
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City | AUSTIN
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State | TX
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Zip | 78704-5722
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Country | US
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Telephone | 512-537-8999
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Fax | 512-628-6460
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Provider Business Mailing Address
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Address Line | 2550 S IH 35 SUITE 215
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City | AUSTIN
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State | TX
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Zip | 78704-5722
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Country | US
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Telephone | 512-537-8999
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Fax | 512-628-6460
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Authorized Official
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Title or Position | PRESIDENT & OWNER
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Name | DR. SIDNEY KIRK CUNNINGHAM
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Credential | D.D.S.
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Telephone | 512-537-8999
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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 | 16135
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License Number State | TX
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