Provider Demographics
NPI:1740232073
Name:WELCH, CHAD ALLEN (DDS)
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:ALLEN
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 1:1720 DUCHESS DR
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-2032
Mailing Address - Country:US
Mailing Address - Phone:303-772-6960
Mailing Address - Fax:
Practice Address - Street 1:1720 DUCHESS DR
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-2032
Practice Address - Country:US
Practice Address - Phone:303-772-6960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1053961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice