Provider Demographics
NPI:1558658112
Name:WELCH, JEFFREY TRENT (DMD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:TRENT
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 1:722 BRIDLE POINTE CV
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-7001
Mailing Address - Country:US
Mailing Address - Phone:801-918-5488
Mailing Address - Fax:
Practice Address - Street 1:722 BRIDLE POINTE CV
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-7001
Practice Address - Country:US
Practice Address - Phone:801-918-5488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-05
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5094305-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT5094305-9922OtherUTAH STATE DENTAL BOARD