Provider Demographics
NPI:1699116921
Name:WELCH, LEEANN SUE (DMD, MPH)
Entity type:Individual
Prefix:DR
First Name:LEEANN
Middle Name:SUE
Last Name:WELCH
Suffix:
Gender:F
Credentials:DMD, MPH
Other - Prefix:
Other - First Name:LEEANN
Other - Middle Name:SUE
Other - Last Name:ROSTAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:903 LADD AVE
Mailing Address - Street 2:
Mailing Address - City:JUNCTION CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97448-8606
Mailing Address - Country:US
Mailing Address - Phone:541-480-6378
Mailing Address - Fax:
Practice Address - Street 1:2522 NW 13TH ST
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-1197
Practice Address - Country:US
Practice Address - Phone:541-480-6378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-15
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD008687122300000X
ORD10362122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist