Provider Demographics
NPI:1295271492
Name:MAURICE J WELCH DDS A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:MAURICE J WELCH DDS A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAURICE
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:WELCH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:907-563-4844
Mailing Address - Street 1:4450 CORDOVA ST STE 210
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-7273
Mailing Address - Country:US
Mailing Address - Phone:907-563-4844
Mailing Address - Fax:907-562-5758
Practice Address - Street 1:4450 CORDOVA ST STE 210
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-7273
Practice Address - Country:US
Practice Address - Phone:907-563-4844
Practice Address - Fax:907-562-5758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-11
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKDD05531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKDD0553OtherSTATE OF ALASKA LICENSE NUMBER
AK1003056Medicaid
AK1003056Medicaid