Individual
KERMIT NEVARO WELCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS MSD
Contact information
Practice address
321 SOUTH L B J DRIVE, SAN MARCOS, TX 78666
(512) 139-6800
(512) 396-8008
Mailing address
321 SOUTH L B J DRIVE, SAN MARCOS, TX 78666
(512) 139-6800
(512) 396-8008
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
7589
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
803444
UNITED CONCORDIA
—
01
—
D07589
BLUE CROSS BLUE SHIELD
—
Enumeration date
09/10/2007
Last updated
09/10/2007
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