Susan M Wellman, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

54472 Issued in CA

Practice address

550 E Washington Ave
Suite 100
Crescent City, CA 95531

Phone

(707) 465-4636

Fax

(707) 465-1983

NPI assigned

Dec 18, 2006

Reactivated

Aug 21, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166400000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1323907200000",
    "number": "1033272406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "670 9TH ST",
            "address_2": "SUITE 203",
            "city": "ARCATA",
            "state": "CA",
            "postal_code": "955216248",
            "telephone_number": "707-826-8633",
            "fax_number": "707-826-8638"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "550 E WASHINGTON AVE",
            "address_2": "SUITE 100",
            "city": "CRESCENT CITY",
            "state": "CA",
            "postal_code": "95531",
            "telephone_number": "707-465-4636",
            "fax_number": "707-465-1983"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WELLMAN",
        "first_name": "SUSAN",
        "middle_name": "M",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-18",
        "last_updated": "2011-12-15",
        "deactivation_date": "2007-07-17",
        "reactivation_date": "2007-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN14964",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "54472",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wanner Chiropractic
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• Fred Carlton Ward, DDS
• Sandra Waters, D.C.
• Kala Weaver
• Carol Westerman, OT
• Myiesha Wheathersbee
• Tara Jane White, LCSW
• Claire Price Williams III, MD
• Mellissa Kaye Williams

• Dentist in Crescent City, CA
• Providers in Crescent City, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.