Provider Demographics
NPI:1023749660
Name:WERGER, MARISA (DMD)
Entity type:Individual
Prefix:
First Name:MARISA
Middle Name:
Last Name:WERGER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:MARISA
Other - Middle Name:MORET
Other - Last Name:MORET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:718 SILVER SPRING AVE
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-4661
Mailing Address - Country:US
Mailing Address - Phone:970-214-3880
Mailing Address - Fax:
Practice Address - Street 1:3221 EASTBROOK DR STE A-101
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-5705
Practice Address - Country:US
Practice Address - Phone:970-407-1020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-23
Last Update Date:2025-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CODEN.002058041223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program