Provider Demographics
NPI:1750498481
Name:WELTER FAMILY DENTISTRY, INC.
Entity Type:Organization
Organization Name:WELTER FAMILY DENTISTRY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:C
Authorized Official - Last Name:WELTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-326-7445
Mailing Address - Street 1:114 E BLACKHAWK AVE
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE DU CHIEN
Mailing Address - State:WI
Mailing Address - Zip Code:53821-1529
Mailing Address - Country:US
Mailing Address - Phone:608-326-7445
Mailing Address - Fax:
Practice Address - Street 1:114 E BLACKHAWK AVE
Practice Address - Street 2:
Practice Address - City:PRAIRIE DU CHIEN
Practice Address - State:WI
Practice Address - Zip Code:53821-1529
Practice Address - Country:US
Practice Address - Phone:608-326-7445
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI0005616-015122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty