MEDICARE: SOUTHEAST DENVER DENTAL ASSOCIATES PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	109316	CO

General Provider Information

NPI Number	:	1538170527
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHEAST DENVER DENTAL ASSOCIATES PC

Provider Business Mailing Address
First Line	:	2660 SOUTH MONACO PKWY
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80222
Country	:	US
Telephone Number	:	303-757-7175
Fax Number	:	303-757-7179

Provider Business Practice Location Address
First Line	:	2660 SOUTH MONACO PKWY
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80222
Country	:	US
Telephone Number	:	303-757-7175
Fax Number	:	303-757-7179

Authorized Official
Title or Position	:	DENTIST PRESIDENT
Name	:	DR. CHAD ALLEN WELCH
Credential	:	DDS
Telephone Number	:	303-757-7175

Provider Enumeration Date	:	08/11/2006
Last Update Date	:	08/22/2020

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