Healthcare Provider Details

I. General information

NPI: 1922854744
Provider Name (Legal Business Name): WELCH DENTAL CARE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2024
Last Update Date: 04/24/2024
Certification Date: 04/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 19TH ST S STE B
SARTELL MN
56377-2104
US

IV. Provider business mailing address

1201 FRANKLIN AVE
SAUK RAPIDS MN
56379-1226
US

V. Phone/Fax

Practice location:
  • Phone: 320-229-2233
  • Fax:
Mailing address:
  • Phone: 320-253-4242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: ADELLE HENNEN
Title or Position: OFFICE MANAGER
Credential:
Phone: 320-253-4242