Provider Demographics
NPI:1841347606
Name:WELK, AMY E (DMD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:E
Last Name:WELK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22830 SW ENO PL
Mailing Address - Street 2:
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-7358
Mailing Address - Country:US
Mailing Address - Phone:503-701-9375
Mailing Address - Fax:
Practice Address - Street 1:18735 SW BOONES FERRY RD
Practice Address - Street 2:
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-8487
Practice Address - Country:US
Practice Address - Phone:503-855-4546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD7369122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR931297806OtherTAX IDENTIFICATION NUMBER