Provider Demographics
NPI:1487826368
Name:JEFFREY W WELNAK DDS SC
Entity Type:Organization
Organization Name:JEFFREY W WELNAK DDS SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:W
Authorized Official - Last Name:WELNAK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:414-545-2050
Mailing Address - Street 1:10533 W NATIONAL AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53227-2041
Mailing Address - Country:US
Mailing Address - Phone:414-545-2050
Mailing Address - Fax:414-545-1630
Practice Address - Street 1:10533 W NATIONAL AVE
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227-2041
Practice Address - Country:US
Practice Address - Phone:414-545-2050
Practice Address - Fax:414-545-1630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-31
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2518122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty