Provider Demographics
NPI:1205351988
Name:WELNAK DENTAL PC
Entity type:Organization
Organization Name:WELNAK DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:A
Authorized Official - Last Name:WELNAK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:603-352-0118
Mailing Address - Street 1:681 COURT ST
Mailing Address - Street 2:
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431-1702
Mailing Address - Country:US
Mailing Address - Phone:603-352-0118
Mailing Address - Fax:603-357-6297
Practice Address - Street 1:681 COURT ST
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-1702
Practice Address - Country:US
Practice Address - Phone:603-352-0118
Practice Address - Fax:603-357-6297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH17351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty