Provider Demographics
NPI:1558485433
Name:WELLER, BARRETT STEWART (DDS)
Entity Type:Individual
Prefix:DR
First Name:BARRETT
Middle Name:STEWART
Last Name:WELLER
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 1:1870 W EL NORTE PKWY
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92026-3343
Mailing Address - Country:US
Mailing Address - Phone:760-489-0866
Mailing Address - Fax:760-489-0866
Practice Address - Street 1:1870 W EL NORTE PKWY
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92026-3343
Practice Address - Country:US
Practice Address - Phone:760-489-0866
Practice Address - Fax:760-489-0866
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39497122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist