Provider Demographics
NPI:1891847521
Name:WELCH, BETSY ROSS (DMD)
Entity Type:Individual
Prefix:DR
First Name:BETSY
Middle Name:ROSS
Last Name:WELCH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 N FLOWOOD DR
Mailing Address - Street 2:SUITE B-1
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39232-9738
Mailing Address - Country:US
Mailing Address - Phone:601-939-7987
Mailing Address - Fax:
Practice Address - Street 1:1050 N FLOWOOD DR
Practice Address - Street 2:SUITE B-1
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39232-9738
Practice Address - Country:US
Practice Address - Phone:601-939-7987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2301-86122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist