Provider Demographics
NPI:1790347599
Name:WELCH, BRENNAN JAMES (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRENNAN
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 1:5765 BOZEMAN DR APT 2212
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-5710
Mailing Address - Country:US
Mailing Address - Phone:512-529-3323
Mailing Address - Fax:
Practice Address - Street 1:15123 PRESTONWOOD BLVD STE 140
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248-4701
Practice Address - Country:US
Practice Address - Phone:972-644-1998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-01
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK72661223G0001X
TX352151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice