Provider Demographics
NPI:1023457835
Name:WELCH, DAVID SHANE (DMD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:SHANE
Last Name:WELCH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8477A COUNTY ROAD 64
Mailing Address - Street 2:SUITE 3
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-8714
Mailing Address - Country:US
Mailing Address - Phone:251-621-1301
Mailing Address - Fax:
Practice Address - Street 1:8477A COUNTY ROAD 64
Practice Address - Street 2:SUITE 3
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-8714
Practice Address - Country:US
Practice Address - Phone:251-621-1301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-14
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL60131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice