Provider Demographics
NPI:1629673058
Name:WERTZ, SHEREE FOSHEE (BS, RDH, OMT)
Entity Type:Individual
Prefix:
First Name:SHEREE
Middle Name:FOSHEE
Last Name:WERTZ
Suffix:
Gender:F
Credentials:BS, RDH, OMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 244
Mailing Address - Street 2:
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-0244
Mailing Address - Country:US
Mailing Address - Phone:815-922-1288
Mailing Address - Fax:
Practice Address - Street 1:19615 GOVERNORS HWY
Practice Address - Street 2:
Practice Address - City:FLOSSMOOR
Practice Address - State:IL
Practice Address - Zip Code:60422-2037
Practice Address - Country:US
Practice Address - Phone:708-221-8343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist