Individual provider Active NPI

Lee J. Weltman, DDS

  • General Practice Dentistry
  • Colchester, VT
National Provider Identifier
1396842407
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
0160001102 Issued in VT
Practice address
245 S Park Dr
Suite 3
Colchester, VT 05446-5972
Phone
(802) 655-5305
Fax
(802) 655-0045
NPI assigned
Sep 20, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 0160001102 VT Primary

Addresses

Primary practice location

245 S Park Dr
Suite 3
Colchester, VT 05446-5972

Mailing address

245 S Park Dr
Suite 3
Colchester, VT 05446-5972
Phone (802) 655-5305

Other identifiers 1

IdentifierTypeStateIssuer
1002700MedicaidVT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150618002171 MA Order and Referring Only - DentistPractitioner - Dentist 7911218813

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
05446MNMDProfessional Counselor
0160001102VTMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1396842407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "245 S PARK DR",
            "address_2": "SUITE 3",
            "city": "COLCHESTER",
            "state": "VT",
            "postal_code": "054465972",
            "telephone_number": "802-655-5305",
            "fax_number": "802-655-0045"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "245 S PARK DR",
            "address_2": "SUITE 3",
            "city": "COLCHESTER",
            "state": "VT",
            "postal_code": "054465972",
            "telephone_number": "802-655-5305",
            "fax_number": "802-655-0045"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WELTMAN",
        "first_name": "LEE",
        "middle_name": "J.",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "VT",
            "license": "0160001102",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1002700",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Colchester, VT

Sources for this page

Verify at the official NPI Registry.