Provider Demographics
NPI:1457313611
Name:CRAIG S WERNETTE DDS PC
Entity Type:Organization
Organization Name:CRAIG S WERNETTE DDS PC
Other - Org Name:LIFETIME DENTAL EXCELLENCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:WERNETTE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-588-6565
Mailing Address - Street 1:17 SOUTH MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CLAWSON
Mailing Address - State:MI
Mailing Address - Zip Code:48017
Mailing Address - Country:US
Mailing Address - Phone:248-588-6565
Mailing Address - Fax:248-588-6567
Practice Address - Street 1:17 SOUTH MAIN ST
Practice Address - Street 2:
Practice Address - City:CLAWSON
Practice Address - State:MI
Practice Address - Zip Code:48017
Practice Address - Country:US
Practice Address - Phone:248-588-6565
Practice Address - Fax:248-588-6567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-04
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010141671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty