Provider Demographics
NPI:1407022312
Name:SCOTT A WELCH DDS PA
Entity Type:Organization
Organization Name:SCOTT A WELCH DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:WELCH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS PA
Authorized Official - Phone:336-288-4499
Mailing Address - Street 1:2016 NEW GARDEN RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410
Mailing Address - Country:US
Mailing Address - Phone:336-288-4499
Mailing Address - Fax:336-286-8180
Practice Address - Street 1:2016 NEW GARDEN RD
Practice Address - Street 2:SUITE D
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410
Practice Address - Country:US
Practice Address - Phone:336-288-4499
Practice Address - Fax:336-286-8180
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SCOTT A WELCH DDS PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6099122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8999107Medicaid