Provider Demographics
NPI:1730259011
Name:WELLER, LORRILEE GAIL (DDS)
Entity type:Individual
Prefix:DR
First Name:LORRILEE
Middle Name:GAIL
Last Name:WELLER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 E DOUGLAS AVE
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-4514
Mailing Address - Country:US
Mailing Address - Phone:619-442-0871
Mailing Address - Fax:619-442-9317
Practice Address - Street 1:290 E DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-4514
Practice Address - Country:US
Practice Address - Phone:619-442-0871
Practice Address - Fax:619-442-9317
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADJ0339681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice