Provider Demographics
NPI:1912013244
Name:WELCH, LARRY G (DDS)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:G
Last Name:WELCH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:LARRY
Other - Middle Name:G
Other - Last Name:WELCH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS, PLLC
Mailing Address - Street 1:1408 JAMES BLVD
Mailing Address - Street 2:
Mailing Address - City:SIGNAL MOUNTAIN
Mailing Address - State:TN
Mailing Address - Zip Code:37377-2630
Mailing Address - Country:US
Mailing Address - Phone:423-886-3649
Mailing Address - Fax:423-886-2726
Practice Address - Street 1:1408 JAMES BLVD
Practice Address - Street 2:
Practice Address - City:SIGNAL MOUNTAIN
Practice Address - State:TN
Practice Address - Zip Code:37377-2630
Practice Address - Country:US
Practice Address - Phone:423-886-3649
Practice Address - Fax:423-886-2726
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS31161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice