Mitchell C. Wellman, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D12610 Issued in MN

Practice address

2001 W Lincoln Ave
Ste. 33
Fergus Falls, MN 56537-1010

Phone

(218) 739-2481

Fax

(218) 739-2178

NPI assigned

Jul 3, 2008

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Lifesmiles Dental LLC

  • General Practice Dentistry
  • Fergus Falls, MN
  • NPI 1578893632
  NPD (past)

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

{
    "created_epoch": "1215043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1247011200000",
    "number": "1841453347",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2001 W LINCOLN AVE",
            "address_2": "STE. 33",
            "city": "FERGUS FALLS",
            "state": "MN",
            "postal_code": "565371010",
            "telephone_number": "218-739-2481",
            "fax_number": "218-739-2178"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 W LINCOLN AVE",
            "address_2": "STE. 33",
            "city": "FERGUS FALLS",
            "state": "MN",
            "postal_code": "565371010",
            "telephone_number": "218-739-2481",
            "fax_number": "218-739-2178"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WELLMAN",
        "first_name": "MITCHELL",
        "middle_name": "C.",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-07-03",
        "last_updated": "2009-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D12610",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Samantha Larae Ward, RN
• Scott Ronald Ward, RPH
• Jessanna Danielle Watts, LPN
• Erica Sue Weatherford, LPN
• Amie Welch, RN
• Courtney Ann Welvaert, RN
• Jacob Allen Wendland, D.P.T
• West Ottertail Transportation
• Samantha West
• Linda Kay Westby, RN, PHN, LSN

• General Practice Dentistry in Fergus Falls, MN
• Providers in Fergus Falls, MN by specialty
• General Practice Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.