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Contact Information

SUSAN WELLER, DMD
1614 WEST LAFAYETTE AVENUE
JACKSONVILLE, IL62650
 Phone: 217-243-1114
 Fax: 217-245-7906
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Dentist

122300000X
Indicates primary specialty

NPI Profile & details for SUSAN WELLER · (Female)

NPI # 1740350529
Status Active
Credentials DMD (Doctor of Medical Dentistry)
Entity Individual
Enumeration date 11/08/2006
Last updated 07/08/2007 - About 19 years ago
Sole proprietor 1 No
Identifiers
  • IL License # 01918328
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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