Provider Demographics
NPI:1841783271
Name:WERTH, JODIE ROCHELLE (DDS)
Entity Type:Individual
Prefix:
First Name:JODIE
Middle Name:ROCHELLE
Last Name:WERTH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:JODIE
Other - Middle Name:ROCHELLE
Other - Last Name:JENNINGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1318 JUDITH DR APT B
Mailing Address - Street 2:
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-4829
Mailing Address - Country:US
Mailing Address - Phone:620-290-2257
Mailing Address - Fax:
Practice Address - Street 1:300 N MAIN ST
Practice Address - Street 2:
Practice Address - City:RUSSELL
Practice Address - State:KS
Practice Address - Zip Code:67665-2731
Practice Address - Country:US
Practice Address - Phone:785-483-2411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-11
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS61403122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist