Provider Demographics
NPI:1467749309
Name:SUSAN M WELCH, DDS PA
Entity Type:Organization
Organization Name:SUSAN M WELCH, DDS PA
Other - Org Name:WRIGHT PARKWAY DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:WELCH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:850-243-1534
Mailing Address - Street 1:106 WRIGHT PKWY SW
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32548-5208
Mailing Address - Country:US
Mailing Address - Phone:850-243-1534
Mailing Address - Fax:850-243-7541
Practice Address - Street 1:106 WRIGHT PKWY SW
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32548-5208
Practice Address - Country:US
Practice Address - Phone:850-243-1534
Practice Address - Fax:850-243-7541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-29
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN15821122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty