Healthcare Provider Details

I. General information

NPI: 1194972687
Provider Name (Legal Business Name): KAREN WELIKY D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2008
Last Update Date: 08/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2636 SE HARRISON ST #B
MILWAUKIE OR
97222-7587
US

IV. Provider business mailing address

2636 SE HARRISON ST #B
MILWAUKIE OR
97222-7587
US

V. Phone/Fax

Practice location:
  • Phone: 503-659-9658
  • Fax: 503-513-9597
Mailing address:
  • Phone: 503-659-9658
  • Fax: 503-513-9597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD6711
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: