Provider Demographics
NPI:1154456259
Name:WELLENREITER, DARREN W (DDS)
Entity Type:Individual
Prefix:MR
First Name:DARREN
Middle Name:W
Last Name:WELLENREITER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8928 E 96TH ST
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-9648
Mailing Address - Country:US
Mailing Address - Phone:317-598-9380
Mailing Address - Fax:317-813-1982
Practice Address - Street 1:8928 E 96TH ST
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-9648
Practice Address - Country:US
Practice Address - Phone:317-598-9380
Practice Address - Fax:317-813-1982
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009628A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice