Healthcare Provider Details

I. General information

NPI: 1780792416
Provider Name (Legal Business Name): FRANK A WELCH PROF CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 CRESTONE AVENUE
ALAMOSA CO
81101
US

IV. Provider business mailing address

PO BOX 738
RYE CO
81069-0738
US

V. Phone/Fax

Practice location:
  • Phone: 719-589-6629
  • Fax:
Mailing address:
  • Phone: 719-489-2067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberHD100460
License Number StateCO

VIII. Authorized Official

Name: FRANK ARTHUR WELCH
Title or Position: PRESIDENT
Credential: DDS
Phone: 719-489-2067