Provider Demographics
NPI:1609054246
Name:WELLENER, LAURA L (DDS)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:L
Last Name:WELLENER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 789
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28370-0789
Mailing Address - Country:US
Mailing Address - Phone:910-295-1010
Mailing Address - Fax:910-295-1367
Practice Address - Street 1:305 PAGE RD. NORTH
Practice Address - Street 2:SUITE 2
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374
Practice Address - Country:US
Practice Address - Phone:910-295-1010
Practice Address - Fax:910-295-1367
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8518122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist