Provider Demographics
NPI:1922196294
Name:WOELL, JOHN M (DENTIST)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:M
Last Name:WOELL
Suffix:
Gender:M
Credentials:DENTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 EAST 66TH STREET
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55423-2798
Mailing Address - Country:US
Mailing Address - Phone:612-861-7109
Mailing Address - Fax:612-253-7422
Practice Address - Street 1:1717 E 66TH ST
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55423-2798
Practice Address - Country:US
Practice Address - Phone:612-861-7109
Practice Address - Fax:612-253-7422
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND8581122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist