Provider Demographics
NPI:1780804849
Name:WELCH, KEVIN EDWARD
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:EDWARD
Last Name:WELCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:567 N BEDFORD ST
Mailing Address - Street 2:P. O. BOX 549
Mailing Address - City:E BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02333-1123
Mailing Address - Country:US
Mailing Address - Phone:508-378-7642
Mailing Address - Fax:508-378-7729
Practice Address - Street 1:567 N BEDFORD ST
Practice Address - Street 2:
Practice Address - City:E BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02333-1123
Practice Address - Country:US
Practice Address - Phone:508-378-7642
Practice Address - Fax:508-378-7729
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA145241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAX11080OtherBLUE CROSS BLUE SHIELD