Provider Demographics
NPI:1346262201
Name:WUERTZ, KAREN MONIQUE (DDS)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:MONIQUE
Last Name:WUERTZ
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 1:21822 JUNIPER WOOD LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-3636
Mailing Address - Country:US
Mailing Address - Phone:757-409-9273
Mailing Address - Fax:
Practice Address - Street 1:7500 CAMBRIDGE ST RM 2548
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-2032
Practice Address - Country:US
Practice Address - Phone:757-409-9273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6896122300000X
TX168131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC899088KMedicaid