Provider Demographics
NPI:1295356590
Name:LANCE J WELCH DMD LLC
Entity Type:Organization
Organization Name:LANCE J WELCH DMD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:J
Authorized Official - Last Name:WELCH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:601-707-7042
Mailing Address - Street 1:1 WOODGREEN PL STE 100
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-8161
Mailing Address - Country:US
Mailing Address - Phone:601-707-7042
Mailing Address - Fax:
Practice Address - Street 1:1 WOODGREEN PL STE 100
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-8161
Practice Address - Country:US
Practice Address - Phone:601-707-7042
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-28
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty