Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 0401007847 | VA |
NPI | 1508841826 |
---|---|
Provider Name | Dr. Preston Quinn Welch |
First Address | Apo, AE 09180 |
Second Address | Apo, AE 09180 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/12/2005 |
Last Update Date | 17/08/2009 |