Provider Demographics
NPI:1790856342
Name:WERRY, PAUL FREDERICK II (DDS)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:FREDERICK
Last Name:WERRY
Suffix:II
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 1:1911 N LEBANON ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:IN
Mailing Address - Zip Code:46052-1506
Mailing Address - Country:US
Mailing Address - Phone:765-482-4538
Mailing Address - Fax:765-482-6640
Practice Address - Street 1:1911 N LEBANON ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:IN
Practice Address - Zip Code:46052-1506
Practice Address - Country:US
Practice Address - Phone:765-482-4538
Practice Address - Fax:765-482-6640
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN73981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice