Healthcare Provider Details

I. General information

NPI: 1003584210
Provider Name (Legal Business Name): WELCH DENTAL CARE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2021
Last Update Date: 09/01/2021
Certification Date: 09/01/2021
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

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

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. COURTNEY WELCH
Title or Position: OWNER
Credential: DDS
Phone: 320-229-2233