Provider Demographics
NPI:1508029299
Name:WELLER, DANIEL JOEL (DMD)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:JOEL
Last Name:WELLER
Suffix:
Gender:M
Credentials:DMD
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 174
Mailing Address - Street 2:530 EAST MAIN ST BLDG A SUITE 1A
Mailing Address - City:CHESTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07930-0174
Mailing Address - Country:US
Mailing Address - Phone:908-879-5333
Mailing Address - Fax:908-879-9402
Practice Address - Street 1:530 EAST MAIN ST
Practice Address - Street 2:BLDG A SUITE 1A
Practice Address - City:CHESTER
Practice Address - State:NJ
Practice Address - Zip Code:07930-0174
Practice Address - Country:US
Practice Address - Phone:908-879-5333
Practice Address - Fax:908-879-9402
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-03
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI010248001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice