Provider Demographics
NPI:1083215487
Name:WERMERSON ORTHODONTICS PROF LLC
Entity Type:Organization
Organization Name:WERMERSON ORTHODONTICS PROF LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:WERMERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:605-274-0555
Mailing Address - Street 1:5200 S CLIFF AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-5400
Mailing Address - Country:US
Mailing Address - Phone:605-274-0555
Mailing Address - Fax:605-274-0155
Practice Address - Street 1:5200 S CLIFF AVE STE 102
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-5400
Practice Address - Country:US
Practice Address - Phone:605-274-0555
Practice Address - Fax:605-274-0155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental