Provider Demographics
NPI:1023210226
Name:WEHRMAN, MARK M (DMD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:M
Last Name:WEHRMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:220 THOMAS MORE PKWY
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW HILLS
Mailing Address - State:KY
Mailing Address - Zip Code:41017-3424
Mailing Address - Country:US
Mailing Address - Phone:859-341-3012
Mailing Address - Fax:859-341-3013
Practice Address - Street 1:220 THOMAS MORE PKWY
Practice Address - Street 2:
Practice Address - City:CRESTVIEW HILLS
Practice Address - State:KY
Practice Address - Zip Code:41017-3424
Practice Address - Country:US
Practice Address - Phone:859-341-3012
Practice Address - Fax:859-341-3013
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY42871223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY61942561Medicaid