Provider Demographics
NPI:1861617615
Name:WELLER, ERIC (DDS)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:
Last Name:WELLER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16912 RIVER ROCK DR
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98037-6959
Mailing Address - Country:US
Mailing Address - Phone:425-308-0977
Mailing Address - Fax:
Practice Address - Street 1:22833 BOTHELL EVERETT HWY
Practice Address - Street 2:SUITE 205
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98021-9385
Practice Address - Country:US
Practice Address - Phone:425-485-6540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA84851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice