Provider Demographics
NPI:1205931375
Name:WELCH, KEVIN JOHN (DDS)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:JOHN
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 1:6919 E 10TH ST
Mailing Address - Street 2:A -1
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4893
Mailing Address - Country:US
Mailing Address - Phone:317-358-8885
Mailing Address - Fax:317-358-8886
Practice Address - Street 1:6919 E 10TH ST
Practice Address - Street 2:A -1
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-4893
Practice Address - Country:US
Practice Address - Phone:317-358-8885
Practice Address - Fax:317-358-8886
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42017122300000X
IN12011453A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201033180Medicaid