Healthcare Provider Details

I. General information

NPI: 1821272394
Provider Name (Legal Business Name): SARAH JO WELCH D.D.S, M.S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2007
Last Update Date: 08/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 W 21ST ST SUITE L1
CLOVIS NM
88101-4087
US

IV. Provider business mailing address

2000 W 21ST ST SUITE L1
CLOVIS NM
88101-4087
US

V. Phone/Fax

Practice location:
  • Phone: 844-317-0938
  • Fax: 575-163-0418
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberTX 23278
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: