Provider Demographics
NPI:1760915714
Name:WELDEN ONDOCSIN DENTISTRY LLC
Entity Type:Organization
Organization Name:WELDEN ONDOCSIN DENTISTRY LLC
Other - Org Name:DECATUR COMPREHENSIVE DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:G
Authorized Official - Last Name:ONDOCSIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:256-350-4616
Mailing Address - Street 1:2691 SANDLIN RD SW STE C
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-7362
Mailing Address - Country:US
Mailing Address - Phone:256-350-4616
Mailing Address - Fax:256-350-4819
Practice Address - Street 1:2691 SANDLIN RD SW STE C
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-7362
Practice Address - Country:US
Practice Address - Phone:256-350-4616
Practice Address - Fax:256-350-4819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-06
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty