Provider Demographics
NPI:1558817239
Name:WERNBERG, EMILY (DDS)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:WERNBERG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:SLATER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:3060 WOODBURY DR
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55129-9617
Mailing Address - Country:US
Mailing Address - Phone:651-587-6789
Mailing Address - Fax:
Practice Address - Street 1:3060 WOODBURY DR
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55129-9617
Practice Address - Country:US
Practice Address - Phone:651-587-6789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-31
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND13756122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist