Provider Demographics
NPI:1679698385
Name:WELCH, JESSE GARDNER JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:JESSE
Middle Name:GARDNER
Last Name:WELCH
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6516 JOHN FREEMAN ST
Mailing Address - Street 2:RM 493
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-3402
Mailing Address - Country:US
Mailing Address - Phone:713-500-4259
Mailing Address - Fax:713-500-4108
Practice Address - Street 1:6516 JOHN FREEMAN ST
Practice Address - Street 2:RM 493
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-3402
Practice Address - Country:US
Practice Address - Phone:713-500-4259
Practice Address - Fax:713-500-4108
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX130491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice