Healthcare Provider Details

I. General information

NPI: 1356495543
Provider Name (Legal Business Name): SCOTT PETERSON WELCH D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

84 PARK AVE
LOVELL WY
82431-1719
US

IV. Provider business mailing address

PO BOX 308
LOVELL WY
82431-0308
US

V. Phone/Fax

Practice location:
  • Phone: 307-548-7501
  • Fax: 307-548-9229
Mailing address:
  • Phone: 307-548-7501
  • Fax: 307-548-9229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number904
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: