Provider Demographics
NPI:1780673350
Name:WELLENSIEK, TODD RICHARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:RICHARD
Last Name:WELLENSIEK
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 1:684 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:TECUMSEH
Mailing Address - State:NE
Mailing Address - Zip Code:68450-2055
Mailing Address - Country:US
Mailing Address - Phone:402-335-3791
Mailing Address - Fax:402-335-3891
Practice Address - Street 1:684 N 5TH ST
Practice Address - Street 2:
Practice Address - City:TECUMSEH
Practice Address - State:NE
Practice Address - Zip Code:68450-2055
Practice Address - Country:US
Practice Address - Phone:402-335-3791
Practice Address - Fax:402-335-3891
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE46671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice