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Individual
SUSAN M WELLMAN
Active
Individual
SUSAN M WELLMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
54472
CA
1223G0001X
General Practice Dentistry
DN14964
FL
Other
Enumeration date
12/18/2006
Last updated
12/15/2011
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