Provider Demographics
NPI:1265492540
Name:WELCH, LEONARD (DDS)
Entity Type:Individual
Prefix:MR
First Name:LEONARD
Middle Name:
Last Name:WELCH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:769 1/2 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43206
Mailing Address - Country:US
Mailing Address - Phone:614-258-3880
Mailing Address - Fax:614-252-5873
Practice Address - Street 1:1493 PARSONS AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43207-1230
Practice Address - Country:US
Practice Address - Phone:614-258-3880
Practice Address - Fax:614-252-5873
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30019298122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0922649Medicaid