Provider Demographics
NPI:1346762424
Name:WERNER, MADALYN FAYE (DMD)
Entity Type:Individual
Prefix:
First Name:MADALYN
Middle Name:FAYE
Last Name:WERNER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 CONGRESS AVE
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54901-7701
Mailing Address - Country:US
Mailing Address - Phone:920-235-3251
Mailing Address - Fax:
Practice Address - Street 1:1720 CONGRESS AVE
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54901-7701
Practice Address - Country:US
Practice Address - Phone:920-235-3251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1001646-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist