Provider Demographics
NPI:1942212634
Name:WELSH, STEPHEN RICHARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:RICHARD
Last Name:WELSH
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:PO BOX R
Mailing Address - Street 2:
Mailing Address - City:MANLY
Mailing Address - State:IA
Mailing Address - Zip Code:50456-0717
Mailing Address - Country:US
Mailing Address - Phone:641-454-2638
Mailing Address - Fax:
Practice Address - Street 1:128 EAST MAIN
Practice Address - Street 2:
Practice Address - City:MANLY
Practice Address - State:IA
Practice Address - Zip Code:50456-0717
Practice Address - Country:US
Practice Address - Phone:641-454-2284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA63461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0154500Medicare ID - Type Unspecified