Provider Demographics
NPI:1952329450
Name:WELCH, TIMOTHY B (MD, DDS)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:B
Last Name:WELCH
Suffix:
Gender:M
Credentials:MD, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 COUNTRY CLUB RD STE 100
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-6045
Mailing Address - Country:US
Mailing Address - Phone:541-465-3939
Mailing Address - Fax:541-465-3946
Practice Address - Street 1:911 COUNTRY CLUB RD STE 100
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-6045
Practice Address - Country:US
Practice Address - Phone:541-465-3939
Practice Address - Fax:541-465-3946
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR20049204E00000X
ORMD200491223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR150939Medicaid
OR150939Medicaid
ORG38801Medicare UPIN