Provider Demographics
NPI:1396165015
Name:WELNAK, JEFFREY W (DDS)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:W
Last Name:WELNAK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-21
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2518122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist