Provider Demographics
NPI:1538212303
Name:WELCH, HAROLD B (DMD)
Entity type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:B
Last Name:WELCH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2909 SPANIEL LN
Mailing Address - Street 2:
Mailing Address - City:SEFFNER
Mailing Address - State:FL
Mailing Address - Zip Code:33584-5912
Mailing Address - Country:US
Mailing Address - Phone:813-689-7450
Mailing Address - Fax:
Practice Address - Street 1:807 DR. MARTIN LUTHER KING BLVD. W.
Practice Address - Street 2:
Practice Address - City:SEFFNER
Practice Address - State:FL
Practice Address - Zip Code:33584
Practice Address - Country:US
Practice Address - Phone:813-684-2279
Practice Address - Fax:813-684-6769
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL108531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBW0139027OtherD.E.A. #
FL10853OtherSTATE LICENSE