# DR. RONALD L. WELLBAUM

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1558466284
- **Gender:** Man
- **Credential:** DDS

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 7205 | WA | Yes |

## Other

- **Enumeration date:** 09/14/2006
- **Last updated:** 03/07/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 00904187 | UNITED CONCORDIA COMPANY | PA |
| 05 | — | 5016910 | — | WA |
| 01 | — | 8924565 | LABOR & INDUSTRIES | WA |