Provider Demographics
NPI:1578623245
Name:WELCH, MAURICE JAMES (DDS)
Entity Type:Individual
Prefix:DR
First Name:MAURICE
Middle Name:JAMES
Last Name:WELCH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4450 CORDOVA STREET
Mailing Address - Street 2:SUITE 210
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-7273
Mailing Address - Country:US
Mailing Address - Phone:907-563-4844
Mailing Address - Fax:
Practice Address - Street 1:4450 CORDOVA ST.
Practice Address - Street 2:SUITE 210
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-7273
Practice Address - Country:US
Practice Address - Phone:907-563-4844
Practice Address - Fax:907-562-5758
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAA05531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKDD0553Medicaid