Provider Demographics
NPI:1154897353
Name:WELCH, BRANDEN M (DDS)
Entity type:Individual
Prefix:DR
First Name:BRANDEN
Middle Name:M
Last Name:WELCH
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 1:716 WRIGHT LN
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MI
Mailing Address - Zip Code:49068-9612
Mailing Address - Country:US
Mailing Address - Phone:567-230-2072
Mailing Address - Fax:
Practice Address - Street 1:505 E ALCOTT ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49001-6144
Practice Address - Country:US
Practice Address - Phone:269-349-2541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-16
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901022826122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist