Provider Demographics
NPI:1831301043
Name:WELK, DONALD AUGUST (DDS)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:AUGUST
Last Name:WELK
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 1:715 NW 45TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118-6633
Mailing Address - Country:US
Mailing Address - Phone:405-702-6372
Mailing Address - Fax:405-525-0219
Practice Address - Street 1:715 NW 45TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-6633
Practice Address - Country:US
Practice Address - Phone:405-702-6372
Practice Address - Fax:405-525-0219
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK35011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice