Individual
JEFFREY A. WELLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
1050 N STATE ST, MEZZANINE LEVEL, CHICAGO, IL 60610-7829
(312) 654-0606
(312) 654-1606
Mailing address
1050 N STATE ST, MEZZANINE LEVEL, CHICAGO, IL 60610-7829
(312) 654-0606
(312) 654-1606
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
19020147
IL
Other
Enumeration date
12/20/2006
Last updated
07/08/2007
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