Provider Demographics
NPI:1659438356
Name:WELKY, LEE A (DMD)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:A
Last Name:WELKY
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 1:21740 S TAMIAMI TRL
Mailing Address - Street 2:SUITE 111
Mailing Address - City:ESTERO
Mailing Address - State:FL
Mailing Address - Zip Code:33928-2819
Mailing Address - Country:US
Mailing Address - Phone:239-949-8282
Mailing Address - Fax:239-221-8477
Practice Address - Street 1:21740 S. TAMIAMI TRAIL
Practice Address - Street 2:SUITE 111
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:33928
Practice Address - Country:US
Practice Address - Phone:239-949-8282
Practice Address - Fax:239-221-8477
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL133081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice