Individual
SHANE MATTHEW WELLINGTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1609 PENNSYLVANIA AVE, EAST LIVERPOOL, OH 43920
(330) 385-1352
(330) 385-7407
Mailing address
1609 PENNSYLVANIA AVE, EAST LIVERPOOL, OH 43920
(330) 385-1352
(330) 385-7409
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
30021714
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2389660
—
OH
Enumeration date
03/22/2006
Last updated
09/28/2012
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