Provider Demographics
NPI:1306190988
Name:JOHN A WERNER PLLC
Entity Type:Organization
Organization Name:JOHN A WERNER PLLC
Other - Org Name:NATURE'S WAY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:WERNER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:509-304-4370
Mailing Address - Street 1:676 VICTORIA DR
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:ID
Mailing Address - Zip Code:83843-7813
Mailing Address - Country:US
Mailing Address - Phone:509-304-4370
Mailing Address - Fax:
Practice Address - Street 1:619 S WASHINGTON ST STE 303
Practice Address - Street 2:
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83843-3063
Practice Address - Country:US
Practice Address - Phone:208-883-7777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-03
Last Update Date:2012-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-44131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty