Provider Demographics
NPI:1518058932
Name:WELCH-STAADT, MARY RUTH (DDS)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:RUTH
Last Name:WELCH-STAADT
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 1:110 E YORK ST
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47872-1732
Mailing Address - Country:US
Mailing Address - Phone:765-569-6185
Mailing Address - Fax:765-569-0016
Practice Address - Street 1:110 E YORK ST
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:IN
Practice Address - Zip Code:47872-1732
Practice Address - Country:US
Practice Address - Phone:765-569-6185
Practice Address - Fax:765-569-0016
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120087401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice