Provider Demographics
NPI:1720462559
Name:SCOTT R. WELCH DMD, PROFESSIONAL LLC
Entity type:Organization
Organization Name:SCOTT R. WELCH DMD, PROFESSIONAL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:WELCH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:303-232-3636
Mailing Address - Street 1:727 SIMMS ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-4792
Mailing Address - Country:US
Mailing Address - Phone:303-323-3636
Mailing Address - Fax:303-232-1016
Practice Address - Street 1:727 SIMMS ST
Practice Address - Street 2:SUITE E
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-4792
Practice Address - Country:US
Practice Address - Phone:303-323-3636
Practice Address - Fax:303-232-1016
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SCOTT R. WELCH DMD, PROFESSIONAL LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-07-10
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6462122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty