Healthcare Provider Details

I. General information

NPI: 1124107024
Provider Name (Legal Business Name): WELCH DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 CRESTONE AVE
ALAMOSA CO
81101
US

IV. Provider business mailing address

206 CRESTONE AVE
ALAMOSA CO
81101
US

V. Phone/Fax

Practice location:
  • Phone: 719-589-6629
  • Fax: 719-589-8410
Mailing address:
  • Phone: 719-589-6629
  • Fax: 719-589-8410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number460
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number6608
License Number StateCO

VIII. Authorized Official

Name: DR. CHRISTOPHER S WELCH
Title or Position: OWNER
Credential: DDS
Phone: 719-587-0207