Healthcare Provider Details

I. General information

NPI: 1891720405
Provider Name (Legal Business Name): FENN HOLDEN WELCH DDS MS LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 08/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8551 WEST LAKE MEAD BLVD STE 261
LAS VEGAS NV
89128-7642
US

IV. Provider business mailing address

8551 WEST LAKE MEAD BLVD STE 261
LAS VEGAS NV
89128-7642
US

V. Phone/Fax

Practice location:
  • Phone: 702-240-2300
  • Fax: 702-240-6006
Mailing address:
  • Phone: 702-240-2300
  • Fax: 702-240-6006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberS359
License Number StateNV

VIII. Authorized Official

Name: DR. FENN HOLDEN WELCH
Title or Position: OWNER DOCTOR
Credential: DDS MS
Phone: 702-240-2300