Provider Demographics
NPI:1710058250
Name:WERNIMONT, DANIEL F (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:F
Last Name:WERNIMONT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:DANIEL
Other - Middle Name:F
Other - Last Name:WERNIMONT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS PC
Mailing Address - Street 1:102 3RD AVE NW
Mailing Address - Street 2:
Mailing Address - City:POCAHONTAS
Mailing Address - State:IA
Mailing Address - Zip Code:50574-1602
Mailing Address - Country:US
Mailing Address - Phone:712-335-4132
Mailing Address - Fax:712-335-4579
Practice Address - Street 1:102 3RD AVE NW
Practice Address - Street 2:
Practice Address - City:POCAHONTAS
Practice Address - State:IA
Practice Address - Zip Code:50574-1602
Practice Address - Country:US
Practice Address - Phone:712-335-4132
Practice Address - Fax:712-335-4579
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA066581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0185249Medicaid