Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 5685 | AZ |
NPI | 1053488650 |
---|---|
Provider Name | Dr. Jared Weston Welch |
First Address | Gilbert, AZ 85296-0702 |
Second Address | Gilbert, AZ 85296-0702 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2006 |
Last Update Date | 08/07/2007 |