Provider Demographics
NPI:1376835884
Name:WELCH, JAMIE LYNNE (RDH)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:LYNNE
Last Name:WELCH
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:MISS
Other - First Name:JAMIE
Other - Middle Name:LYNNE
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:PO BOX 250
Mailing Address - Street 2:BAD RIVER CLINIC BILLING OFFICE
Mailing Address - City:ODANAH
Mailing Address - State:WI
Mailing Address - Zip Code:54861-0250
Mailing Address - Country:US
Mailing Address - Phone:715-682-7133
Mailing Address - Fax:715-685-7848
Practice Address - Street 1:72718 MAPLE STREET
Practice Address - Street 2:BAD RIVER HEALTH CLINIC DENTAL
Practice Address - City:ODANAH
Practice Address - State:WI
Practice Address - Zip Code:54861
Practice Address - Country:US
Practice Address - Phone:715-682-7133
Practice Address - Fax:715-685-7848
Is Sole Proprietor?:No
Enumeration Date:2011-05-03
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6880-16124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist