Provider Demographics
NPI:1376657502
Name:WELCH, JOAN D (DDS)
Entity Type:Individual
Prefix:MS
First Name:JOAN
Middle Name:D
Last Name:WELCH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3041 DR MARTIN LUTHER KING DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71107-4705
Mailing Address - Country:US
Mailing Address - Phone:318-227-3350
Mailing Address - Fax:318-222-2979
Practice Address - Street 1:160 BROAD ST # STREET02903
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903
Practice Address - Country:US
Practice Address - Phone:401-521-2255
Practice Address - Fax:401-521-1145
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDEN02852122300000X
LA4827122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist