MEDICARE: FENN HOLDEN WELCH DDS MS LTD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	S359	NV

General Provider Information

NPI Number	:	1891720405
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FENN HOLDEN WELCH DDS MS LTD

Provider Business Mailing Address
First Line	:	8551 WEST LAKE MEAD BLVD
Second Line	:	STE 261
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-7642
Country	:	US
Telephone Number	:	702-240-2300
Fax Number	:	702-240-6006

Provider Business Practice Location Address
First Line	:	8551 WEST LAKE MEAD BLVD
Second Line	:	STE 261
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-7642
Country	:	US
Telephone Number	:	702-240-2300
Fax Number	:	702-240-6006

Authorized Official
Title or Position	:	OWNER DOCTOR
Name	:	DR. FENN HOLDEN WELCH
Credential	:	DDS MS
Telephone Number	:	702-240-2300

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	08/29/2007

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