Provider Demographics
NPI:1376625038
Name:WELCH, CHARLES DANIEL JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:DANIEL
Last Name:WELCH
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1343 2ND LOOP RD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29505-2841
Mailing Address - Country:US
Mailing Address - Phone:843-665-8176
Mailing Address - Fax:843-665-2601
Practice Address - Street 1:1343 2ND LOOP RD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29505-2841
Practice Address - Country:US
Practice Address - Phone:843-665-8176
Practice Address - Fax:843-665-2601
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC19731223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics