Provider Demographics
NPI:1043352313
Name:WERMUTH, NATALIE
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:WERMUTH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 CHARLOTTE DR
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31410-1913
Mailing Address - Country:US
Mailing Address - Phone:912-898-0090
Mailing Address - Fax:912-898-3993
Practice Address - Street 1:107 CHARLOTTE DR
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31410-1913
Practice Address - Country:US
Practice Address - Phone:912-898-0090
Practice Address - Fax:912-898-3993
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA121631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice