Provider Demographics
NPI:1861669145
Name:WELDEN, CONNIE LYNN (RDH)
Entity Type:Individual
Prefix:MRS
First Name:CONNIE
Middle Name:LYNN
Last Name:WELDEN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:MISS
Other - First Name:CONNIE
Other - Middle Name:LYNN
Other - Last Name:LATTNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:318 RIDGE RUN TRL
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-8667
Mailing Address - Country:US
Mailing Address - Phone:803-732-5808
Mailing Address - Fax:
Practice Address - Street 1:318 RIDGE RUN TRL
Practice Address - Street 2:
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-8667
Practice Address - Country:US
Practice Address - Phone:803-732-5808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA5605124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist