Provider Demographics
NPI:1174885180
Name:WELCH, JONATHAN H (DMD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:H
Last Name:WELCH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10420 DECATUR BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89141-8718
Mailing Address - Country:US
Mailing Address - Phone:702-527-4644
Mailing Address - Fax:
Practice Address - Street 1:10420 DECATUR BLVD STE 110
Practice Address - Street 2:SUITE 110
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89141-8718
Practice Address - Country:US
Practice Address - Phone:702-527-4644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-14
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT4130122300000X
NV6289122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist