Healthcare Provider Details

I. General information

NPI: 1730131491
Provider Name (Legal Business Name): LAWRENCE JAMES WELSH D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 09/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 MIDWAY MALL MIDWAY MALL
ELYRIA OH
44035-2470
US

IV. Provider business mailing address

13323 SPRUCE RUN DR APT 205
NORTH ROYALTON OH
44133-7474
US

V. Phone/Fax

Practice location:
  • Phone: 440-324-3385
  • Fax:
Mailing address:
  • Phone: 440-541-6529
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30-016958
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: