Healthcare Provider Details

I. General information

NPI: 1952329450
Provider Name (Legal Business Name): TIMOTHY B WELCH MD, DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 02/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 COUNTRY CLUB RD STE 100
EUGENE OR
97401-6045
US

IV. Provider business mailing address

911 COUNTRY CLUB RD STE 100
EUGENE OR
97401-6045
US

V. Phone/Fax

Practice location:
  • Phone: 541-465-3939
  • Fax: 541-465-3946
Mailing address:
  • Phone: 541-465-3939
  • Fax: 541-465-3946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number20049
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: