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General NPI Number Information
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NPI Number | 1467749309
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Entity Type | Organization
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Legal Business Name | SUSAN M WELCH, DDS PA
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Dates
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Enumeration Date | 06/29/2011
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Last Update Date | 06/29/2011
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Provider Practice Location Address
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Address Line | 106 WRIGHT PKWY SW
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City | FORT WALTON BEACH
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State | FL
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Zip | 32548-5208
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Country | US
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Telephone | 850-243-1534
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Fax | 850-243-7541
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Provider Business Mailing Address
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Address Line | 106 WRIGHT PKWY SW
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City | FORT WALTON BEACH
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State | FL
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Zip | 32548-5208
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Country | US
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Telephone | 850-243-1534
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Fax | 850-243-7541
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. SUSAN M WELCH
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Credential | DDS
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Telephone | 850-243-1534
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN15821
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License Number State | FL
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