Provider Demographics
NPI:1316108905
Name:WELS, ROSE MARIE (DDS)
Entity type:Individual
Prefix:DR
First Name:ROSE
Middle Name:MARIE
Last Name:WELS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 98
Mailing Address - Street 2:111 W SNOW STREET
Mailing Address - City:LA FARGE
Mailing Address - State:WI
Mailing Address - Zip Code:54639-0098
Mailing Address - Country:US
Mailing Address - Phone:608-625-2490
Mailing Address - Fax:
Practice Address - Street 1:111 W SNOW STREET
Practice Address - Street 2:
Practice Address - City:LA FARGE
Practice Address - State:WI
Practice Address - Zip Code:54639-0098
Practice Address - Country:US
Practice Address - Phone:608-625-2490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-17
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI34981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice