MEDICARE: BENJAMINE AUSTIN WELCH DDS

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	PENDING	MO

General Provider Information

NPI Number	:	1962026542
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENJAMINE AUSTIN WELCH DDS

Provider Business Mailing Address
First Line	:	118 E 29TH ST # 118
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64108-3805
Country	:	US
Telephone Number	:	918-760-9908
Fax Number	:

Provider Business Practice Location Address
First Line	:	2310 HOLMES ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64108-2602
Country	:	US
Telephone Number	:	816-404-2222
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/30/2020
Last Update Date	:	05/30/2020

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