MEDICARE: JEFFREY W WELNAK DDS SC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	2518	WI

General Provider Information

NPI Number	:	1487826368
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEFFREY W WELNAK DDS SC

Provider Business Mailing Address
First Line	:	10533 W NATIONAL AVE
Second Line	:
City	:	WEST ALLIS
State	:	WI
Zip	:	53227-2041
Country	:	US
Telephone Number	:	414-545-2050
Fax Number	:	414-545-1630

Provider Business Practice Location Address
First Line	:	10533 W NATIONAL AVE
Second Line	:
City	:	WEST ALLIS
State	:	WI
Zip	:	53227-2041
Country	:	US
Telephone Number	:	414-545-2050
Fax Number	:	414-545-1630

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JEFFREY W WELNAK
Credential	:	DDS
Telephone Number	:	414-545-2050

Provider Enumeration Date	:	03/31/2008
Last Update Date	:	06/16/2008

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