Provider Demographics
NPI:1588644413
Name:WERNER, MICHAEL EDWARD (DMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:EDWARD
Last Name:WERNER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3425 ENSIGN RD NE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-5425
Mailing Address - Country:US
Mailing Address - Phone:360-456-5678
Mailing Address - Fax:360-456-1238
Practice Address - Street 1:3425 ENSIGN RD NE
Practice Address - Street 2:SUITE 310
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5425
Practice Address - Country:US
Practice Address - Phone:360-456-5678
Practice Address - Fax:360-456-1238
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WADE000099131223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery