Provider Demographics
NPI:1306017538
Name:WERNICK, NEIL (DDS)
Entity Type:Individual
Prefix:DR
First Name:NEIL
Middle Name:
Last Name:WERNICK
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 1:175 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06052-1316
Mailing Address - Country:US
Mailing Address - Phone:860-224-1285
Mailing Address - Fax:
Practice Address - Street 1:175 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06052-1316
Practice Address - Country:US
Practice Address - Phone:860-224-1285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-15
Last Update Date:2008-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3523122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist