Individual
JODY A WELLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
360 W SCHICK RD STE 17, BLOOMINGDALE, IL 60108-2965
(708) 805-6565
Mailing address
PO BOX 27046, SCOTTSDALE, AZ 85255-0134
(708) 805-6565
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019020585
IL
Other
Enumeration date
06/23/2008
Last updated
01/03/2023
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