Provider Demographics
NPI:1689765646
Name:WERTHER, PATTI LEE (DMD)
Entity Type:Individual
Prefix:DR
First Name:PATTI
Middle Name:LEE
Last Name:WERTHER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 E LANCASTER AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ARDMORE
Mailing Address - State:PA
Mailing Address - Zip Code:19003-2321
Mailing Address - Country:US
Mailing Address - Phone:610-649-2470
Mailing Address - Fax:610-896-5425
Practice Address - Street 1:233 E LANCASTER AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:ARDMORE
Practice Address - State:PA
Practice Address - Zip Code:19003-2321
Practice Address - Country:US
Practice Address - Phone:610-649-2470
Practice Address - Fax:610-896-5425
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-020687-L1223P0221X
PADS020687L1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
23-2258555OtherTAX ID NUMBER