Provider Demographics
NPI:1083106165
Name:WILLWERTH, KRISTEN (DDS)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:WILLWERTH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 PHOENIX DR
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-4534
Mailing Address - Country:US
Mailing Address - Phone:717-267-2059
Mailing Address - Fax:
Practice Address - Street 1:475 PHOENIX DR
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-4534
Practice Address - Country:US
Practice Address - Phone:717-267-2059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-04
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0416381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice