Provider Demographics
NPI:1699170712
Name:DAVID SHANE WELCH DMD PC
Entity type:Organization
Organization Name:DAVID SHANE WELCH DMD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:SHANE
Authorized Official - Last Name:WELCH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:251-377-7255
Mailing Address - Street 1:6300 AIRPORT BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-3158
Mailing Address - Country:US
Mailing Address - Phone:251-342-0015
Mailing Address - Fax:
Practice Address - Street 1:6300 AIRPORT BLVD STE A
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-3158
Practice Address - Country:US
Practice Address - Phone:251-342-0015
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-31
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6013261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental