Provider Demographics
NPI:1891331666
Name:WERTH FAMILY DENTAL PA
Entity Type:Organization
Organization Name:WERTH FAMILY DENTAL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JODIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:WERTH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:620-290-2257
Mailing Address - Street 1:2703 HALL ST STE A1
Mailing Address - Street 2:
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-1899
Mailing Address - Country:US
Mailing Address - Phone:785-628-2424
Mailing Address - Fax:
Practice Address - Street 1:2703 HALL ST STE A1
Practice Address - Street 2:
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-1899
Practice Address - Country:US
Practice Address - Phone:785-628-2424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-26
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty