Provider Demographics
NPI:1619987500
Name:WERNER, ALBERT MARK (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:MARK
Last Name:WERNER
Suffix:
Gender:M
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:N3645 OLD M. RD.
Mailing Address - Street 2:
Mailing Address - City:WEST SALEM
Mailing Address - State:WI
Mailing Address - Zip Code:54669
Mailing Address - Country:US
Mailing Address - Phone:608-786-1315
Mailing Address - Fax:608-782-2815
Practice Address - Street 1:2030 7TH ST S
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-5202
Practice Address - Country:US
Practice Address - Phone:608-782-2812
Practice Address - Fax:608-782-2815
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI480G122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist